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1     tH'f 


AN 


m$$tttatitm 


ON 


FEIGNED  DISEASES 


BY 


THOMAS  W.  BLATCHFORD,A.B. 


Mika,  endow'd  with  every  charm  to  bless, 
Has  no  design,  but  on  her  husband's  .peace  : 
He  lov'd  her  much;  and  greatly  was  he  mov'd 
At  small  inquietudes  in  her  he  lov'd. 
*'  How  charming  this'''' — The  pleasure  lasted  long, 
Now  every  day  the  "jits'"1  come  thick  and  strong  : 
At  last  he  found  the  charmer  only  feign'd, 
And  was  diverted  when  he  should  be  pain'd. 
What  greater  vengeance  have  the  gods  in  store  ? 
How  tedious  life  now  she  can  plague  no  more  ! 
She  tries  a  thousand  arts ;  but  none  succeed: 
She's  fore'd  a  fever  to  procure  indeed  : 
Thus  strictly  prov'd  this  virtuous  loving'  wife, 
Her  husband's  pain  was  dearer  than  her  life. 

YOUNG,  SAT.   VI, 


NEW-YORK : 

FORBES  &   CO.   FRINTERS,    CORNER   OF    6REEXW1C 
AND    VESEY-STREETS. 


181 


/j.(^2'$£frCB 


"BGI 


Printed,  under  the  Authority  of  the  College  of  Physicians 
and  Surgeons,  as  the  Statute  directs. 


TO  THE 


REV.  SAMUEL  BLATCHFORfi,  D.  & 


THIS  DISSERTATION 


IS    INSCRIBED^ 


WITH   SENTIMENTS 


OF    FILIAL   GRATITUDE    AND    RESPECT, 


BY    HIS    SON, 


THE  AUTHOR, 


r/ 


'^// 


.  3©  / 


TO 
SAMUEL  BORROWE,  M.  D, 

ONE  OF  THE  SURGEONS 
OF    THE 


NEW-YORK  HOSPITAL,  $c. 


THIS  DISSERTATION 

IS    DEDICATED, 

WITH    FEELINGS    OF    GRATITUDE, 

WHICH    OUGHT    NOT    TO    BE    SUPPRESSED, 

AND    OF    PERSONAL    REGARD, 

ENTERTAINED    FOR    HIM, 

BY    HIS    PUPIL, 

THE  AUTHOR. 


TO    THE 

PROFESSORS  OF  THE 

COLLEGE  OF  PHYSICIANS  AMD  SURGEONS, 

©F   THE  UNIVERSITY  OF  THE  STATE  OF  NEW-YORK, 


GENTLEMEN, 

It  may  be  gratifying  to  you,  to  know  the 
reasons  which  influenced  me,  in  selecting  for  my 
Inaugural  Dissertation,  a  subject,  at  once  so  singu- 
lar and  intricate  as  that  of  Feigned  Diseases. 

About  two  years  since,  I  received  the  appoint- 
ment of  "  Resident  Physician"  to  the  "  New- York 
State  Prison."  Whilst  performing  the  duties  in- 
cumbent on  me  in  that  station,  I  witnessed  nu- 
merous instances  of  the  most  subtile  deception  prac- 
tised by  the  criminals ;  contrived  with  the  greatest 
ingenuity,  in  order  to  excite  the  commiseration  of 
their  keepers,  and  exempt  themselves  from  the  per- 
formance of  the  tasks  imposed  upon  them.  I  found 
great  difficulty  in  detecting  these  impositions, 
especially  in  convalescents  ;  and  having  no  author 


8 

to  whom  I  could  resort  as  a  guide,  I  hesitated  mucns 
always  keeping  in  view  the  inhumanity  of  neglect- 
ing real  pain  and  distress.  I  might  suspect  the  re- 
ality of  their  disease ;  but  in  a  case  so  important  as 
that  of  life  or  death  in  the  issue,  it  was  hard  for 
me  to  convince  my  own  mind,  and  still  harder  to 
act  in  opposition  to  their  reiterated  complaints. 

These  circumstances  caused  me  to  regret,  that 
there  was  nothing  to  which  I  could  refer  to  satisfy 
my  doubts  and  suspicions,  and  induced  me  to  offer, 
as  the  last  requisite  for  my  degree,  what  I  could 
collect  from  observation  and  acquire  from  reading 
on  the  subject  which  now  claims  your  attention. 
If  what  I  have  advanced,  shall  preserve  any  from 
being  the  dupes  of  imposition,  or  throw  light  upon 
a  subject  which,  till  of  late,  has  not  been  consider- 
ed as  essential  in  the  education  of  a  medical  stu- 
dent, either  in  this  country  or  in  England,  my 
principal  object  is  attained ;  and  I  shall  ever  be 
proud  to  recollect  it. 

I  am,  gentlemen,  with  sentiments  of  respect  and 
gratitude,  your  humble  servant, 

THOMAS  W.  BLATCHFORD. 

New- York,  April  7,  1817- 


DISSERTATION 


ON 


FEIGNED  DISEASES. 

After  making  a  few  cursory  observations  upon 
the  less  important  kind  of  Feigned  Diseases,  which 
we  commonly  meet  with  in  the  higher  ranks  of  so- 
ciety, we  shall  minutely  investigate  the  principal 
diseases,  which  are  feigned  by  the  lower  classes  of 
people. 

There  is  scarcely  a  physician,  who  has  had  even 
a  tolerable  share  of  practice  for  a  single  year,  but 
has  witnessed  jnatancos-ef  the  most  artful  decep- 
tion in  patients ;  contrived  with  such  ingenuity  and 
precision,  and  attended  with  such  apparent  reality, 
that  it  has  demanded  his  utmost  assiduity  and  atten- 
tion to  detect  it :  and  sometimes  it  has  even  to- 
tally eluded  his  observation.  But  we  should  re- 
member, that  hypocrites  in  disease,  deserve  as 
much  the  censure  of  every  honest  member  of 
the  community,  as  hypocrites  in  religion.  As 
it  is  the  duty  of  the  divine  to  point  out  the  distin- 
guishing traits  of  the  one,  so  it  is  the  duty  of  the 
physician  to  examine  and  understand  the  charac- 
teristics of  the  other. 

It  may  be  asked,  what  end  individuals  propose 
to  gain  by  resorting  to  this  detestable  species  of 


10 

imposition,  especially  the  wealthy, who  may  furnish 
themselves  with  every  comfort  which  can  render 
life  agreeable  ?  Their  ends,  I  answer,  are  more 
numerous  than  the  diseases  which  they  feign.  If 
it  is  ever  right,  "  to  do  evil  that  good  may  come," 
their  intentions  may  sometimes  be  laudable.  As  an 
example  we  may  adduce  that  of  David,  king  of 
Israel,  who  feigned  himself  mad,  that  he  might 
rescue  his  life  from  the  hands  of  Achish.*  Another 
instance,  equally  commendable,  is  that  of  Junius 
Brutus,  who  feigned  idiotism  and  became  a  court 
fool,  to  preserve  his  life  from  the  hands  of  Tarquin, 
who  had  already  murdered  his  father  and  eldest 
brother.f 

But  good  intentions  actuate  few,  in  comparison 
with  the  number  of  those  whose  motives  are  of  a  vi- 
cious and  despicable  character.  History  furnishes 
numerous  examples  of  crimes  perpetrated  under 
the  garb  of  false  disease.  Hume,  in  his  history  of 
England,  informs  us,  that  Alfric,  governor  of 
Mercia,  under  Etheldred,  unwilling  to  become  an 
open  traitor  to  his  country,  endeavoured  to  con- 
ceal his  crime,  under  the  cover  of  pretended  sick- 
ness; during  which  time,  according  to  agreement, 
his  troops  united  with  the  Danes.  Etheldred, 
himself,  about  seven  years  afterwards,  from  pure 
cowardice,  was  induced  to  feign  illness.  He  re- 
mained at  London,  and  heard  without  any  emo- 
tion his  troops  calling  aloud  for  their  leader ;  he 
witnessed  their  confusion  and  dissention;  and  at 

*  1  Sam.  ssi.  12-13.        4  Goldsmith's  Rome,  p.  92. 


11 

length  had  the  satisfaction  of  beholding  his  kingdom 
become  subject  to  a  foreign  despot.  Another  in- 
stance shall  suffice  our  purpose,  which  is  the 
impious  case  of  Amnon*  son  of  David,  who  feigned 
himself  sick,  tLat  he  might  rob  a  sister  of  her  virtue, 
whilst  she  was  ministering  to  his  pretended  wants. 

But  without  referring  to  remote  ages,  we  are  ac- 
quainted with  those  in  the  present  day,  whose  mo- 
tives are  as  detestable,  although  the  consequences 
of  their  deception  be  not  so  fatal  as  those  of  Amnon. 
Among  these  we  cannot  but  remark  a  class  of  fe- 
males, who  seem  to  take  a  secret,  strange  delight,  in 
witnessing  the  distress  and  sympathy  of  a  friend, 
excited  merely  by  their  dissemblance  of  some  pain 
or  disease.  Whatever  be  their  object,  whether  to 
test  affection  ;  to  behold  the  tender  emotions  of  the 
heart;  or  to  excite  wonder  and  astonishment ;  the 
head  and  the  heart  of  such,  must  indeed,  be  in  a 
pitiable  situation,  who  find  a  pleasure  in  descending 
to  practices  so  low  and  unnatural,  so  full  of  hy- 
pocrisy and  deceit. 

I  well  recollect  an  instance  of  this  kind,  in  a 
wealthy  and  accomplished  female,  who  moved  in 
the  higher  circles  of  life.  Her  countenance  was 
naturally  pale,  and  her  aspect  sickly,  which  greatly 
favoured  the  deception.  A  gentleman  of  learning 
and  respectability  paid  her  his  addresses — After  a 
short  time  they  were  married.  The  complaint  she 
assumed,  was  as  singular  as  capricious ;  it  was  that  of 

*  2  Samuel,  xiii» 


12 

fainting  &t  will,  as  was  afterwards  discovered.  At  first 
it  called  into  action,  all  the  tender  feelings  of  her  af- 
fectionate, unsuspecting  husband;  but  fromthefact 
of  its  being  often  repeated,  he  began  to  convince  him- 
self, that  there  was  more  of  deception  than  reality  in 
her  complaints.  He  observed,that  afterthe  paroxysm 
was  over,  she  appeared  as  well  and  cheerful  as 
usual ;  that  it  originated  from.the  most  trifling  and 
opposite  causes,  and  often  whilst  performing  the  du- 
ties of  her  station  at  the  head  of  her  table.  I  have 
repeatedly  seen  her  fall  back  in  her  chair  in  an 
apparent  syncope,  but  in  all  these  instances,  she 
was  neverknown  to  injure  herself  by  falling.  Upon 
these  discoveries,  her  husband  ceased  to  give  him- 
self any  uneasiness,  and  she  in  her  turn,  rinding  that 
he  had  become  insensible  to  feelings  of  sympathy, 
relinquished  any  further  practices  of  deception. 

A  similar  instance,  is  that  of  a  lady,  who  was 
greatly  addicted  to  the  same  habit  ;  frequently, 
as  often  as  two  or  three  times  in  the  course  of  an 
evening,  in  an  assembly  or  ball-room  ;  but  never, 
unless  a  particular  gentleman  was  present;  and  not 
even  then,  unless  she  could  conveniently  fall  into 
his  arms.  These  instances  satisfactorily  prove, 
that  there  are  certain  females,  who  derive  more  real 
gratification  from  falsely  complaining,  than  from 
the  acknowledgment  of  an  uninterrupted  enjoy- 
ment of  health. 

But  it  must  be  admitted,  that  the  other  sex  are 
by  no  means  backward  in  practising  this  sort  of 
imposition  ;  although  it  is  less  common  with  them^ 
than  with  females. 


43 

I  knew  a  young  man  who  used  to  complain  when 
in  the  company  of  a  lady  whom  he  expected  shortly 
to  marry,  for  no  other  reason,  as  he  himself  assured 
me,  than  to  enjoy  the  pleasure  of  her  sympathy. 

It  is  no  uncommon  thing  to  find  vanity,  and  the 
fear  of  an  injured  reputation,  the  cause  of  feigned 
disease ;  usually  to  conceal  complaints  of  a  disrepu- 
table character.  Women  affect  Ascites  or  Tym- 
panites, when  they  are  conscious  that  imprudence, 
and  crime,  have  laid  the  foundation  of  a  different 
complaint.* 

After  the  memorable  battle  of  Waterloo,  nothing 
was  more  common,  than  for  young  men  to  parade 
the  public  walks  of  the  cities,  and  thickly  inhabited 
towns  of  England,  with  their  arms  in  slings,  or 
their  legs  secured  with  bandages,  and  limping  with 
crutches  under  their  arms,  with  a  view  of  reaping 
the  vainest  species  of  honour  from  the  passing 
stranger,  or  the  still  more  credulous  inhabitant. 

But  of  all  motives  for  feigning  disease,  that  of 
smuggling  is  the  most  strange.  The  following  in- 
stance  is  a  fact,  which  happened  not  long  since  :  A 
lady  of  this  country,  while  on  a  tour  through  Eu- 
rope, was  very  clandestinely  seized  with  the  dropsy 
on  her  return  from  the  continent  to  England  ;  but 
she  was  unexpectedly  cured  of  it  by  the  custom- 
house officer,  who  discovered  that  the  cause  of  it 
was  a  large  quantity  of  silks  and  laces,  which  she 
had  concealed  around  her  body  in  order  to  free 
them  from  the  customary  duties. 


*  This  subject  more  properly  belongs  to  another  branch  of  Medical  Jurisprudeac? 


14 

Children,  likewise,  are  very  frequently  the  sub- 
jects of  feigned  diseases  ;  and  it  is  hardly  credible 
to  what  extent  they  carry  their  deception  ;  how  ex- 
actly they  wiil  represent  the  disease  ;  how  effectu- 
ally blind  the  eyes  of  their  friends,  and  successfully 
puzzie  the  most  skilful  and  discerning  physicians, 
Wot  two  years  since,  a  boy,  the  son  of  an  inti- 
mate friend  of  mine,  was  affected  very  strangely 
and  suddenly.    Upon  my  second  visit,  I  began  to 
perceive  something  very  unnatural  and  contradic- 
tory in  his  case.     A  few  hours  of  close  and  scrutin- 
izing observation,  convinced  me,  that  there  was 
more  of  art,  than  nature  in  his  complaint ;  but  I 
dared  not  reveal  my  suspicions.    At  the  request  of 
his  friends,  two  physicians  of  eminence  were  con- 
sulted :  it  was  not  long  before  we  perfectly  under- 
stood  each  other;  but  from  the  confidence  his  friends 
reposed  in  him,  and  from  the  danger  of  the  correct- 
ness of  our  opinions  being  questioned,  we  conclu- 
ded that  it  was  not  expedient  to  acquaint  the  friends 
with  the  real  nature  of  the  case.    But  as  the  patient 
had  arrived  at  that  age,  in  which  he  could  discern 
the  difference  between  good  and  evil,  we  determin- 
ed that  a  private,  serious  conversation  with  him, 
would  be  the  best  way  to  allay  the  anxiety  of  the 
family,  and  preserve  the  youth  from  an  open  dis- 
grace.   This  was  put  in  execution,  and  we  had  the 
satisfaction  to  witness  the  desired  effect.   His  reco- 
very, however,  was  almost  too  instantaneous  to 
pass  unnoticed. 

We  often   see  a  child,  who  has  a  difficult  or 
nupleasant  task  to  perform ;    or   who  has  been 


n 

guilty  of  some  misdemeanor,  and  from  its  detec- 
tion, expecting  punishment,  feign  some  disease, 
thereby  hoping  to  screen  himself  from  duty  or 
correction.  Perhaps  a  violent  head-ache  is  assumed 
— a  pain  in  the  limbs,  commonly  called  growing 
pains — a  pain  in  the  bowels — an  ear-ache — a  tooth- 
ache— and  sometimes  children  carry  their  decep- 
tion so  far,  as  to  affect  paralysis  and  even  convul- 
sions ;  to  refuse  all  kinds  of  food ;  and,  because 
fluids  are  the  common  drink  of  the  sick,  they  crave 
the  same,  and  subsist  almost  altogether  on  them. 
Not  only  in  this  way,  wili  they  afflict  themselves, 
but  will  often  submit  to  the  most  active  treatment, 
the  more  effectually  to  deceive. 

We  may  here,  also,  notice  the  deception  practi- 
sed by  children  while  convalescing.  They  gen- 
erally receive  so  much  pleasing  attention,  and  are 
indulged  with  luxuries  so  gratifying  to  their  appe- 
tites, that  it  is  hard  for  them  to  yield  that,  which, 
on  ordinary  occasions,  they  cannot  obtain:  and  this 
selfishness  induces  them  to  deceive  their  friends  and 
physicians,  by  exaggerating  their  complaints,  and 
feigning  symptoms,  which  have  no  foundation. 
Hence  we  condemn  the  common  practice  of  en- 
couraging children,  during  sickness,  by  any  parti- 
cular marks  of  indulgence.  Common  as  these  cases 
are,  and  trifling  as  they  may  appear  to  many,  they 
are  nevertheless  among  the  most  unpleasant,  with 
which  the  physician  has  to  contend.  Should  his 
judgment  err  in  pronouncing  complaints  fictitious, 
when  they  prove  to  be  real,  he  will  doubtless  com- 
mit his  reputation  :  and  this,  added  to  the  danger 


16 

of  withholding  active  remedies,  fully  establishes  the 
importance  of  a  thorough  and  perfect  acquaint- 
ance with  symptoms,  before  we  hazard  our  opinion,, 
and,  especially,  before  we  attempt  to  prescribe. 

If,  in  a  disease  which  we  suspect  to  be  feigned, 
we  do  not  find  the  characteristic  symptoms  present ; 
and  if  we  can  discover  any  end  which  we  think  our 
patient  proposes  to  gain  by  sickness,  then  a  little 
cross-questioning  will  easily  enable  us  to  judge  con- 
cerning the  reality  of  his  complaints.  If  any  doubt 
should  exist  in  our  minds,  and  our  opinions  be  re- 
quested, prudence  will  dictate  as  to  the  propriety 
of  giving  a  decided  answer ;  but  if  no  opinion  is 
requested,  it  would  be  better  for  us  to  keep  our 
diagnosis  to  ourselves. 

If  a  child  complains  of  a  tooth-ache,  we  can  soon 
discover  if  it  is  real,  by  observing  its  apparent  ease 
during  the  relation  of  some  interesting  story,  or 
when  its  attention  is  otherwise  directed.  We  can 
often,  too,  satisfy  our  minds  by  threatening  to  extract 
the  tooth ;  or  by  proposing  some  other  disagreeable 
remedy,  and  if  it  is  feigned,  the  pretended  pain 
will  most  likely  subside,  before  either  are  put  in 
execution. 

If  it  be  a  violent  head  ache,  of  which  the  patient 
complains,  and  we  can  discover  no  other  symp- 
toms of  disease  present — If  the  head  is  not  unusu- 
ally hot— If  the  skin  is  not  hot  and  dry,  (unless 
heated  by  sitting  over  a  warm  fire  ;  for,  it  must 
be  recollected,  that  this  alone  will  produce  an 
apparent  fever,  a  quick  pulse,  a  dry  hot  skin,  thirst 
and  stupor)— If  the  bowels  are  not  costive,  or  other- 


17 

wise    diseased,  we   may  justly  suspect  its  reali- 

In  these  cases,  a  gentle  cathartic  will  satisfy  the 
friends  of  the  patient,  whilst  the  physician  gives 
himself  no  further  trouble. 

If  a  pain  in  the  bowels  be  feigned  by  children, 
let  us  first,  ascertain  the  state  of  the  evacuations, 
and  endeavour  to  learn,  whether  any  particular 
marks  of  disease  preceded  the  attack ;  whether  the 
pulse  be  hard,  small  and  quick  ;  the  countenance 
unusually  pale  ;  the  eyes  languid ;  the  abdomen 
hard  and  knotted,  and  whether  there  be  any  wincing 
under  the  hand.  If  these  symptoms  are  absent,  we 
may  rest  assured,  that,  if  there  be  any  reality  in  the 
complaint,  it  is  not  of  sufficient  importance  to  oc- 
casion any  uneasiness  or  anxiety.  But  still,  under 
these  circumstances,  no  injury  can  accrue  to  the 
patient  from  administering  to  him  a  small  dose  of 
opium  ;  if  the  pain  does  really  exist,  it  will  have  no 
effect :  if  it  be  pretended,  it  will  produce  drowsi- 
ness and  sleep.  A  gentle  cathartic  may  be  given 
with  perfect  safety,  let  the  issue  be  what  it  may. 

The  feigned  indisposition  of  children  is  generally 
some  temporary  complaint,  as  that  of  pain  ;  be- 
cause they  are  aware  that  this  excites  the  greatest 
commiseration,  and  is  their  best  defence  during 
their  troubles. 

We  shall  here  mention  two  cases  of  feigned  dis- 
ease in  children,  to  show  how  far  they  are  capable 
of  carrying  their  deceptions,  and  how  difficult  it  is 
to  detect  them. 

The  first,  which  I  shall  relate,  is  that  of  a  lady 

3 


18 

in  this  city,  now  enjoying  health  and  happiness^ 
and  surrounded  by  an  agreeable  family.  When 
at  nine  years  of  age,  for  some  unknown  cause, 
she  felt  a  great  reluctance  to  attend  her  school. 
Her  request  of  absenting  herself  from  it,  not 
being  complied  with  by  her  parents,  she  thought 
her  safest  and  only  expedient,  to  gain  her  object, 
would  be  to  feign  some  disease.  Accordingly,  she 
complained  of  head-ache,  loss  of  appetite,  and  inabi- 
lity to  move  her  lower  extremities,  together  with  a 
most  excruciating  pain.  A  physician  was  called ; 
he  found  her  sitting  in  a  chair,  her  body  bent  for- 
ward, and  her  feet  placed  upon  a  foot-stove,  but 
without  any  marks  of  disease.  She  would  not  willing- 
ly allow  any  one  to  touch  her,  or  even  approach  her; 
and  when  she  was  carried  from  her  chair  to  her  bed, 
her  pains  were  apparently  excruciating.  Cathartics 
were  given  her  ;  external  applications,  in  the  form 
of  friction,  and  blisters  were  also  recommended  : 
but  to  these,  she  would  not  submit;  and  on  account 
of  the  agonies  into  which  she  appeared  to  be  thrown 
by  the  attempt,  they  were  not  used.  This  state  of 
things  lasted  ten  or  twelve  days.  Her  parents  and 
friends  became  much  alarmed;  and  the  physician,  in 
attendance,  did  not  dare  to  calm  their  anxiety,  by 
disclosing  his  suspicions  on  the  subject. 

About  this  time,  a  fire  broke  out  in  the  neigh- 
bourhood, and  during  the  general  commotion  and 
alarm  of  the  family,  who  hastened  to  witness  the 
scene  ;  she  forgot  her  distress  ;  arose  from  her  seat, 
and  mingled  with  the  throng  at  the  door.  She  soon 
found  that  her  deception  was  detected,  and  that  it 


19    > 

was  useless  for  her  any  longer  to  persist.  She  inv 
mediately  resumed  her  duties  at  school ;  gave  no 
farther  anxiety  to  her  friends,  and  confirmed  the 
opinion  of  her  physician. 

Another  remarkable  instance,  is  that  of  a  lad, 
who,  at  the  age  of  eight  years,  had  been  detected 
in  mischief,  and  as  he  knew  he  had  no  apology  to 
offer,  which  could  screen  him  from  the  rod,  he  com- 
plained of  sickness  at  his  stomach,  and  while  he 
imagined,  that  he  was  unnoticed  by  any  one,  he 
irritated  his  throat  with  his  finger,  which  produced 
vomiting.  Presently  he  began  to  kick  and  strike 
those  around  him  ;  and  finally,  feigned  a  convul- 
sion so  completely,  as  to  deceive  his  parents  ;  and, 
by  his  apparent  agony,  so  far  excited  their  com- 
passion, that  they  forgave  the  offence  of  which  he 
had  been  guilty,  and  he  saved  himself  from  a  de- 
served chastisement. 

I  might  detail  many  more  instances  of  deception 
among  children,  equally  singular  and  artful ;  but 
those  we  have  mentioned  will  be  sufficient.  I 
proceed,  therefore,  to  the  second  and  more  im- 
portant part  of  the  subject. 


THE    CONSIDERATION 

OF   THOSE    DISEASES   WHICH   ARE   MOST   COMMONLY    FEIGNED 
BY  THE  LOWER  CLASSES  OF  PEOPLE ; 

WITH  VIEWS  AND  INTENTIONS  MORE  INJURIOUS  TO  SOCIETY. 

Some  for  fraud — some  to  cover  crimes — some  to  be  liberated 
from  punishment  in  reality,  as  well  as  in  anticipation — 
and  some  for  purposes  of  mendicity. 

— • — 

These  subjects  claim  the  attention  of  physicians 
generally,  because  their  opinion  is  often  demanded 
in  a  court  of  justice ;  and  especially  of  those,  whose 
professional  duties  connect  them  with  prisons,  hos- 
pitals, work-houses,  the  army  or  the  navy. 

And  here  a  few  general  observations  are  neces- 
sary, respecting  those  circumstances,  into  which  it 
is  proper  we  should  inquire,  that  a  correct  opinion 
may  be  formed  of  a  disease  supposed  to  be  feigned. 

We  should  ascertain  the  character  of  the  indivi- 
dual; the  benefit  which  he  may  expect  to  derive 
from  disease  ;  the  nature  of  his  complaint,  whether 
chronic,  or  one  which  will  soon  terminate. 

It  is  very  uncommon  for  the  lower  class  of  pre- 
tenders to  endeavour  to  imitate  any  acute^Hiseases; 
for  they  are  aware,  that  their  duration  is  too  short 
to  answer  their  purpose.  External  disorders  are 
likewise  rarely  pretended,  from  the  circumstance 
of  their  being  too  readily  detected.  We  should 
also  examine  the  plausibility  of  the  account  given 


21 

of  the  disease,  and  try,  whether  by  cross-question- 
ing, the  patient  can  be  made  to  contradict  i.i        If. 

It  is  proper  for  us  to  learn  too,  with  what  readi- 
ness the  medicine  prescribed  is  taken ;  and  parti* 
cularly,  to  observe  the  account  given  of  its  opera- 
tion by  the  patient  himself.  We  should  also  be 
careful  that  the  nurse  does  not  neglect  her  duty  in 
administering  the  remedies  ;  for  although  pretend- 
ers generally  appear  over-anxious  to  obtain  relief, 
I  have  seen  them,  when  a  dose  of  salts  has  been 
prescribed,  thinking  themselves  unobserved,  either 
throw  it  on  the  ground  or  in  their  bosoms. 

Much  may  therefore  be  gathered  from  watching 
the  patient  when  he  knows  nothing  of  it ;  for  by 
this,  we  may  judge  whether  his  conduct  is  uniform 
and  consistent  with  his  complaints.  It  is  also  of 
great  use  to  visit  him,  when  he  least  expects  it,  and 
when  he  is  off  his  guard  ;  to  attend  particularly  to 
the  history  of  his  complaint,  and  carefully  watch 
its  progress. 

Although  we  allow,  that  there  is  generally  much 
difficulty  attending  the  detection  of  this  kind  of  im- 
position, still  it  must  be  admitted,  that  every  disease 
has  some  peculiar  characteristics,  which  are  indepen- 
dent of  the  relation  given  by  the  patient.  This  may 
be  taken  as  a  general  rule,  although  there  may  be 
some  exceptions.  The  only  means,  therefore,  by 
which  the  impostor  has  to  expect  success  in  his 
deception,  is,  to  lurk  behind  the  comparatively  se- 
cure shelter  of  the  great  variety  of  appearances, 
under  which  the  same  disease  shows  itself.  And 
as  these  are  so  numerous:  as  diseases  are  so  differ- 


22 

cut  in  their  accession,  progress  and  termination : 
unless  those  external  and  evident  characteristics  are 
absent,  none  but  the  ignorant,  the  inexperienced, 
and  the  most  imprudent,  would  ever  pronounce  a 
disease  to  be  feigned.  The  prudent  physician, 
however,  for  his  security,  remembers  that  in  all  the 
varieties  of  disease,  nature  never  contradicts  her- 
self. To  explain  my  meaning :  a  patient  cannot 
be  affected  with  cephelalgia,  without  other  apparent 
symptoms  ;  either  the  eyes,  the  countenance,  the 
skin  or  the  pulse  must  show  it :  neither  can  a  per- 
son feign  catalepsy,  and  remain  motionless,  during 
the  repeated  application  of  the  electric  shock. 
Upon  this  principle,  therefore,  the  physician  ven- 
tures a  decided  judgment,  that  if  he  can  discover 
evident  and  satisfactory  contradiction,  he  rests  as- 
sured, that  such  complaints  have  no  place  in  the 
long  catalogue  of  human  ailments. 

Discretion  will  suggest  many  other  circumstan- 
ces, which  will  assist  us  in  detecting  imposition. 
Let  our  treatment  of  such  individuals  be  influenced 
by  the  circumstances  under  which  they  are  placed. 
Is  he  a  prisoner  suffering  a  cruel  confinement  ?  hu: 
manity  dictates  that  we  should  temper  our  severity 
with  mildness.  Is  he  a  vile  impostor,  practising  de- 
ception, for  the  sake  of  gain,  or  the  perpetration 
of  an  impious  crime  ?  we  should  almost  forget  mer- 
cy. Torture,  however,  or  very  severe  treatment, 
as  a  general  rule,  had  better  be  avoided  as  a  test,  un- 
less it  would  he  advisable  in  the  management  of 
the  real  disease.  Threats  will  often  be  found  of 
much  use. 


23 

Having  made  these  cursory  observations  on  the 
mode  of  detecting  imposition,  our  next  business 
is,  the  consideration  of  some  of  those  diseases 
which  have  been  most  frequently  feigned,  and  which 
have  caused  physicians  the  greatest  difficulty  to 
detect :  we  shall  commence  with 

MANIA. 
Mania  is  frequently  dissembled  by  the  perpe- 
trator of  crime,  to  escape  the  sentence  of  the  law, 
or  to  mitigate  the  severity  of  punishment.     We 
find   it  pretended   by  sailors    and    soldiers,  who 
would  rather  inhabit  the  cells  of  an  asylum,  and 
wear  the  chains  of  madmen,  than  perform  their  or- 
dinary duty.     And  we  sometimes  find  it  pretended 
for  purposes  of  mendicity.     If  man,  deprived  of 
reason,  has  nothing  to  distinguish  him  from  the 
brutes  which  perish,  but  his  form,  to  what  may  we 
compare  that  man,  who,  in  the  full  possession  of  his 
faculties,  would  wish  to  be  thought  mad  ?  But  such 
instances  are  by  no  means  rare  ;  and  to  distinguish 
between  the  dexterous  imitation,  and  the  real  dis- 
ease's a  province  of  medical  jurisprudence  equally 
delicate,  difficult,  and  important :  and  we  cannot 
but  remark,  that  it  shows  a  great  degree  of  igno- 
rance, as  well  as  a  great  want  of  liberality,  in  the 
advocates  of  criminal  or  civil  law,  to  demand  of  the 
physician,  a  positive  testimony  where  truth  and  na- 
ture speak  with  so  much   ambiguity,   that   every 
honest  mind  cannot  fail  to  be  influenced,  by  pru- 
dent hesitation.  Mania,  is  one  of  the  most  subtile  of 
diseases;  and  as  its  varieties  are  so  great,  and  its  na- 
ture is  so  little  understood,  it  is  frequently  feigned 


24 

In  order  to  form  the  most  correct  opinion,  we 
should  first  review  the  more  common  predisposing 
causes..  Of  these,  the  melancholic  temperament  is 
considered  prominent.  This  is  characterised  by  dark 
complexion,  dark  hair,  eyes  and  skin,  a  strong  ve- 
nereal appetite,  habitual  costiveness,  rigid  fibre, 
and  an  inclination  to  sedentary  habits.  It  is  sup- 
posed by  many  to  be  hereditary  ;  if  there  be  any 
such  disposition  in  the  family,  it  may  influence  our 
opinion.  "  Retarded  catamenia,  but  especially  a 
suddenly  suppressed  evacuation,  or  long  obstruc- 
tion succeeding  great  regularity,  in  some  female 
habiis,  have  induced  predisponent  tendency  to  in- 
sanity."* Injuries  of  the  head  in  early  life,  predis- 
poses to  insanity,  as  well  as  the  occurrence  of  some 
severe  disease,  as  Phrenitis,  Typhus,  Syphilis,  and 
the  abuse  of  mercury.  Age  is  generally  enume- 
rated among  the.  predisposing  causes  of  insanity  : 
neither  the  very  young,  nor  the  very  old,  are  often 
affected  with  it ;  for  it  has  been  observed  to  occur 
most  frequently  in  persons  between  thirty  and 
forty  years  of  age.  Hill  asserts,  that  Mania  is 
never  idiopathic,  but  has  for  its  foundation,  some 
corporal  disease. 

Secondly — Inquire  into  the  exciting  causes  of 
insanity  ;  as  grief,  anger,  joy,  fear,  love,  blows  on 
the  head,  &c. 

Thirdly — Observe  the  history  of  the  complaint, 
to  ascertain  whether  the  accession  was  sudden,  or 
whether  the  premonitory  signs  of  Mania  were  ob- 

*  Hill  on  Insanity,  p.  119. 


25 

served,  i.  e.  if  the  perception  of  the  supposed  ma- 
niac was  any  ways  erroneous,  whether  the  memory 
was  observed  occasionally  to  fail ;  whether  errors 
in  judgment  were  observable,  and  whether  the  ima- 
gination was  particularly  wild. 

Fourthly — Examine  into  the  present  state  of  his 
health.  In  order  to  do  which,  a  knowledge  of  the 
symptoms  characterising  Mania  must  be  known : 
the  enumeration  of  them  will  be  sufficient.  They 
are  a  red  face,*  peculiar  wildness  of  countenance, 
rolling  and  glistening  of  the  eyes,  a  diminution  of 
the  irritability  of  the  body  as  it  respects  the  effects 
of  cold,  hunger  and  watching,  a  full  strong  pulse ; 
and  the  patient  is  generally  affected  with  costive- 
ness,  and  loss  of  sensibility  in  the  stomach,  together 
with  a  peculiar  smell. 

"  A  few  days  spent  in  the  circumspect  examina- 
tion to  which  every  lunatic  is  entitled,  with  as 
complete  a  knowledge  of  all  the  antecedent  cir- 
cumstances of  his  history  as  can  be  obtained,  will 
commonly  enable  the  person  who  has  diligently 
studied  the  nature  and  effects  of  insanity,  to  ascer- 
tain its  actual  or  feigned  presence."! 

Attention  to  the  peculiar  cast  of  countenance 
winch  characterises  a  maniac,  is  of  but  little  use  to 
those  who  have  not  had  the  benefit  of  considera- 
ble experience. 

In  general,  insane  persons  wish  not  to  be  thought 
so,  and  the  suspicion  of  their  being  thought  insane 

*  I  am  aware  this  is  doubted  by  many,  but  assert  it  upon  the  authority  of  Boe>- 
aave.  Van  Sweten,  Cullen,  &c. 

*  Hill  on  Insanity,  p.  351. 

4 


26 

by  their  friends,  often  sets  them  in  a  most  violent 
rage.  Hence  they  are  endeavouring  to  conceal 
from  observation,  those  lapses  of  thought,  memory 
and  expression,  which  are  tending  every  moment 
to  betray  them.  But  the  imitator  of  this  disease, 
often  proves  by  his  actions  and  his  words,  that  he 
thinks  himself  deranged ;  and  instead  of  appearing 
insulted  at  the  mention  of  it,  by  a  bystander,  ap- 
pears pleased.  His  paroxysms  too  are  generally 
observed  to  be  much  worse  when  his  physician  or 
attendant  is  present.  External  appearances,  how- 
ever, may  be  carried  to  great  lengths ;  and,  if  no 
others  are  observed,  it  is  possible  to  deceive  the 
best  informed  in  the  character  of  insanity. 

Mr.  Hill,  (whose  book  on  insanity  is  well  worth 
perusing)  lays  much  stress  upon  the  peculiar  odour 
which  he  observes  "is  never  wanting  in  the  mental- 
ly deranged,  in  defiance  of  all  personal  delicacy."* 

We  cannot  however  admit  this  symptom  to  be 
as  universally  present,  as  Mr.  Hill  affirms ;  since, 
in  many  cases  of  real  and  long  continued  insanity, 
now  in  the  Lunatic  Asylum  of  this  city,  it  is  not, 
nor  has  it  been  present ;  or,  if  it  has  existed,  it  has 
not  been  detected ;  although,  when  its  absence  is 
accompanied  with  the  absence  of  other  essential 
symptoms,  it  assists  to  strengthen  our  suspicions. 

The  mode  he  recommends  for  detecting  this 
odour  is  "  to  enter  the  bed-room  of  the  subject  on 
his  first  awaking.  After  having  slept  in  a  small, 
ill-ventilated  apartment,  in  sheets  and  body  linen 

*  Fare  393. 


27 

occupied  by  him  for  some  time,  the  curtains  are 
now  to  be  opened  by  the  inspector.  Inhaling  the 
effluvia  under  these  circumstances,  it  is  scarcely 
possible  to  be  mistaken."* 

But  if  our  suspicions  are  strong,  unless  they  ap- 
proach to  real  conviction,  we  should  be  careful  to 
conceal  them  from  the  patient :  assent  to  all  he 
says,  and  treat  the  case  the  same  as  if  fully  con- 
vinced the  disease  was  real. 

Maniacs  not  believing  themselves  unwell,  are 
generally  very  unwilling  to  take  medicine,  or  have 
any  thing  done  for  them  by  their  physician,  but  the 
generality  of  pretenders  are  very  anxious  for  re- 
lief. 

As  a  diminution  of  the  sensibility  of  the  alimen- 
tary canal,  and  particularly  the  stomach,f  is  almost 
universally  attendant  upon  mania;  the  adminis- 
tration of  a  strong  solution  of  the  Tart.  Ant.  un- 
known to  the  pretender  or  suspected  person  may 
assist  the  fallibility  of  human  judgment.     "  When 

*  Ibid,  page  396. 

f  Mr.  Haslam  thinks  the  torpor  of  the  bowels  and  the  insensibility  of  the  stomach, 
are  by  no  means  constant  symptoms  in  mania.  His  words  are,  "  An  opinion  has 
long  prevailed,  that  mad  people  are  particularly  constipated,  and  likewise  extremely 
difficult  to  be  purged.  From  all  the  observations  I  ha-7e  been  able  to  make,  insane 
patients  on  the  contrary,  are  of  very  delicate  and  irritable  bowels,  and  are  well  and 
copiously  purged  by  a  common  cathartic  draught."*  From  one  grain  and  a  half  to 
two  grs.  of  Tart.  Ant.  has  been  the  usual  dose,  which  has  hardly  ever  failed  to 
procure  full  vomiting,  page  329.  But  the  observations  of  Pinel,  Crichton,  Ferriar, 
and  many  other  eminent  writers,  together  with  the  observation  of  a  number  of 
physicians  in  this  city,  lead  me  to  think  Mr.  Haslam  is  in  an  error.  Mr.  Male  says 
he  has  "  seen  six  grains  of  Tart.  Ant.  given,  and  large  doses  of  drastic  cathartics 
taken,  without  producing  any  effect.  A  pint  of  the  strongest  infusion  of  Senna,  has 
sometimes  given  only  one  or  two  evacuations.  {Male's  Judiciary  or  Forensic 
Medicine, p.  165. 

*  Page  32i}  Haslam  on  Madness. 


28 

a  common  dose  takes  a  full  and  powerful  effect^ 
deception  will  be  more  than  half  ascertained  .;  be- 
cause in  every  stage  of  approaching,  or  actual  in- 
sanity, such  an  effect  never  follows  such  an  admin- 
istration, more  especially  under  the  maniacal  form, 
which  is  that  most  commonly  attempted  to  be  per- 
sonated. "* 

Pretenders  to  mania  can  seldom  do  with  as  little 
sleep  as  characterises  the  real  disease ;  for,  upon 
observing  the  true  maniac,  we  constantly  find  him 
talking  to  some  supposed  person  during  the  night. 

Another  method,  sometimes  recommended  for 
detecting  feigned  mania,  is  stripping  the  person  in 
the  cold,  and  leaving  his  clothes  by  him,  that  if  he 
feels  inclined,  he  may  put  them  on. 

A  maniac  not  minding  shame  or  cold,  will  not 
trouble  himself,  but  remain  in  the  same  situation; 
but  the  pretender  feeling  sensibly  the  effects  of 
cold,  endeavours  to  put  them  on  again  to  keep 
himself  warm.  Upon  this  test,  however,  we  do  not 
place  much  dependance,  unless  in  conjunction  with 
stronger  evidences;  for  Mr.  Haslam  observes— 
"Some  maniacs  refuse  all  covering;  but  these  are 
not  common  occurrences. "f 

But  what  we  are  to  rely  most  upon  in  the  detec- 
tion of  this  species  of  feigned  disease,  is  constantly 
watching  the  patient,  observing  him  when  he  is  un- 
conscious of  it,  visiting  him  when  he  least  expects 
it,  and  closely  examining  him  at  every  visit ;  pre- 
scribing in  his  hearing,  severe  and  active  remedies,, 

*  Hill  on  Insanity,  p.  396.  f  Haslam  on  Madness,  p.  97 


29 

Co  be  followed  up  until  a  change  takes  place  ;  and 
when  we  find  our  suspicions  pretty  well  founded^ 
that  old  remedy,  the  whip  ;  which  in  the  manage- 
ment of  real  maniacs  is  now  generally  disused;  may 
often  be  employed  with  much  benefit. 

After  the  relation  of  two  or  three  cases,  we  shall 
dismiss  this  part  of  our  subject. 

"  A  man  of  forty-five  years  of  age,  confined  in 
the  felon  department  of  Bicetre,  on  account  of 
his  political  opinions,  was  guilty  of  numerous  acts 
of  extravagance,  made  many  absurd  speeches,  and 
at  length  succeeded  in  obtaining  his  removal  to  the 
lunatic  department  of  the  same  place. 
"  This  happened  saysPinel  before  my  appointment. 
In  the  course  of  a  month  after  my  entrance  upon  the 
functions  of  my  office,  I  determined  to  examine 
carefully  into  the  history  and  state  of  his  malady, 
in  order  to  ascertain  correctly  the  class  of  the  dis- 
order to  which  his  case  belonged.   For  this  purpose 
I  frequently  visited  his  chambers.  At  every  visit  he 
exhibited  some  new  antic.     Sometimes  he  wrapped 
up  his  head  in  the  clothes,  and  refused  to  answer  my 
questions.  At  other  times,  he  poured  forth  a  torrent 
of  unmeaning,  incoherent  jargon  ;  on  other  occa- 
sions he  assumed  the  tone  of  an  inspired,  or  affect- 
ed the  airs  of  great  personage.     The  assumption 
of  so  many  and  opposite  characters,  convinced  me 
that  he  was  not  well  read  in  the  history  of  insanity, 
and  that  he  had  not  studied  the  character  of  those 
whom  he  endeavoured  to  counterfeit.     The  usual 
changes  in  the  expression  of  the  eyes,  and  other 
features  characteristic  of  a  nervous  maniacal  ex 


30 

citement,  were  likewise  wanting.  I  sometimes  list- 
ened  at  the  door  of  his  chamber  in  the  course  of  the 
night,  when  I  invariably  found  him  asleep,  which 
agreed  with  the  report  of  the  hospital  watchman, 
He  one  day  escaped  from  his  chamber,  while  it  was 
cleaning  and  setting  in  order,  took  up  a  stick  and 
applied  it  with  great  effect  to  the  back  of  a  domes- 
tic, in  order  to  impress  him  and  others  with  an  idea 
of  his  violence  and  fury. 

"  All  these  facts  which  I  collected  and  compared 
in  the  course  of  one  month,  appeared  to  character- 
ise no  decided  variety  of  mania,  but  rather  a  great 
desire  of  counterfeiting  it."* 

Hill  relates  the  following  singular  case  of  an  idle 
young  man,  who  enlisted  in  the  army ;  "  but  not 
liking  hard  duty,  affected  insanity,  and  obtain- 
ed his  discharge;  finding  he  must  still  work  for  his 
living,  he  became  sane  and  enlisted  again.  In  a  short 
time  he  renewed  his  old  tricks  of  playing  the  mani- 
ac, he  was  confined,  but  the  truth  being  suspect- 
ed, a  threatened  flogging  caused  him  to  steer  a 
middle  course,  very  troublesome  to  all  about  him. 

"  The  regiment  being  ordered  to  this  city,  I  was 
desired  by  his  colonel  to  see  him,  and  report  on  his 
case,  on  conversing  with  him,  I  assented  to  all  he 
said  -3  told  him  mistakes  had  happened  respecting 
his  deplorable  case,  which  arising  from  deep-seated 
disease,  would  require  a  suitable  regimen  and  a 
little  medicine  to  restore  so  able  a  soldier  to  his 
duty.     Two  vitriolic  powders,  of  five  grains  eachs 

*  Pinel  en  Insanity,  p.  283. 


31 

given  in  a  dark  room,  fasting,  and  nothing  allowed 
to  drink,  the  straight  waistcoat,  and  a  link  attached 
to  one  leg,  changed  his  tone  very  soon.  The  medi- 
cine did  its  duty ;  he  spoke  highly  of  the  benefit 
received,  and  on  a  repetition  of  it  three  times  a 
week  with  suitable  diet,  he  became  a  new  man,  re- 
joined his  troop,  and  continued  from  1796,  to  the 
peace  of  Amiens,  a  good  soldier."* 

"Zacheus  relates  a  case  in  which  a  physician 
proposed  flogging  a  person  who,  he  supposed,  feign- 
ed insanity,  saying,  that  if  it  was  not  feigned,  it 
would  doubtless  be  of  service;  and  if  it  was,  it  would 
cure  him.  The  proposal  of  the  remedy  in  the  pre- 
sence of  the  patient  soon  cured  him."f 

An  instance  occurred  in  the  Lunatic  Asylum  in 
this  city,  during  the  late  war.  A  soldier  who  had  en- 
listed, and  who  afterwards  thought  he  would  rather 
enjoy  the  company  of  his  family,  than  perform  the 
duties  of  the  army,  feigned  mania.  He  was  admit- 
ted into  the  asylum,  and  his  wife  then  obtained  cer- 
tificates, that  her  husband  was  "  confined  in  the  Lu- 
natic Asylum;"  and,upon  presenting  it  to  the  proper 
officer,  she  obtained  his  discharge  from  the  army. 
His  end  being  answered,  he  soon  became  sane,  and 
left  the  asylum  within  twelve  days  from  his  first  ad- 
mittance.$ 

In  the  life  of  H.  M.  Smith,  who  is  confined  in  the 
Simsbury  mines,  there  is  a  curious  account  of  his 
feigning  insanity  during  his  confinement  in  jail  be- 


*  Hill  on  Insanity,  p.  393.  f  Dr.  Stringham's  MSS.  Lectures. 

|  For  this  information,  T  am  indebted  to  Mr.  Saoford,  the  Superintendent 


32 


lore  his  trial  came  on,  in  order  to  impress  the  court 
with  the  idea  that  he  was  insane,  and  thereby  hoping 
either  to  evade,  or  mitigate  the  sentence  of  the 


iaw. 


* 


Some  years  since,  a  murder  was  perpetrated  in 
Ireland  by  an  individual  who  assumed  mania  as  the 
cover  of  his  crime,  and  succeeded.  He  was  a  per- 
son of  dissipated  habits  and  of  violent  passions ; 
and  having  inflicted  the  mortal  wound,  and  there 
being  no  possibility  of  his  escaping  the  messengers 
of  justice,  he  feigned  madness.  During  the  whole 
time  of  his  confinement  in  prison,  previous  to  the 
day  of  trial,  his  conduct  was  violent  and  his  con- 
versation incoherent :  he  totally  neglected  his  per- 
son ;  suffered  his  beard  to  grow  long,  and  contract- 
ed a  filthy  and  disgusting  appearance.  When  he 
was  to  be  tried,  it  was  with  great  difficulty  the  of- 
ficers could  bring  him  into  court,  and  he  was  no 
sooner  placed  at  the  bar,  than  he  looked  wildly 
round  upon  the  audience,  and  being  an  athletic 
man,  by  a  sudden  effort,  he  sprang  across  the  coun- 
sel table,  seized  the  judge  by  the  collar,  and  from 
the  extravagance  of  his  behaviour,  he  was  pro- 
nounced insane,  and  discharged  as  such.  He  em- 
braced the  earliest  opportunity  of  leaving  his  coun- 
try, came  to  the  United  States,  and  died  a  short 
lime  ago  in  one  of  the  western  counties  of  this  state. 

Mr.  Male  gives  it  as  his  opinion,  that  Billing- 
ham,  who  shot  Percival  in  the  house  of  Commons, 
was  insane.     And  he  further  believes,  that  Nichol- 


*  For  the  particulars  of  this  case,  I  must  refer  to  a  small  book  published  during 
the  !a??  year,  entitled  "  The-  Mysterious  Stranger. 


33 

son,  who  was  executed  for  the  murder  of  Mr.  and 
Mrs.  Bonar  at  Chiselhurst,  was  mad.* 

MELANCHOLIA. 

Another  disease  of  the  mind,  which  is  frequently 
feigned,  but  seldom  for  any  very  injurious  purpo- 
ses, is  Melancholia.  The  present  commiseration 
which  it  excites, is  but  small  in  comparison  with  that 
which  is  produced  by  diseases  more  easily  imitated. 
It  neither  covers  crime,  nor  mitigates  punishment : 
neither  is  it  considered  as  an  excuse  to  free  the  in- 
dividual from  labour:  all,  therefore,  which  the  pre- 
tender to  Melancholia  can  expect,  is  the  pity  of  his 
friends.  Under  these  circumstances,  we  conceive 
the  definition  of  Melancholia  will  answer  our  pur- 
pose. Cullen  defines  it  "  a  partial  insanity  with- 
out dyspepsia."f  Pinel  defines  it  thus — "  Delirium 
exclusively  upon  one  subject:  no  propensity  to  acts 
of  violence,  independant  of  such  as  may  be  impres- 
sed by  a  predominant  and  chimerical  idea ;  free 
exercise  in  other  respects,  of  all  the  faculties  of  the 
understanding ;  in  some  cases,  equanimity  of  dis- 
position or  a  state  of  unruffled  satisfaction  ;  in 
others,  habitual  depression  and  anxiety,  and  fre- 
quently a  moroseness  of  character,  amounting  even 
to  the  most  decided  misanthropy,  and  sometimes 
with  an  invincible  disgust  with  life." t 

Boerhaave  defines  Melancholia  to  be  that  disease 
"in  which  a  patient  lies  long  and  obstinately  deli- 
rious, without  a  fever,  and  always  intent  upon  one 
and  the  same  thought." 


''  T,  163,    f  Nosology,     i  Pinel  on  Fnsanitv,  p.  14!?, 


34 

IDIOTISM 

Is  the  next  affection  of  the  mind  which  claims  our 
attention. 

"  An  idiot,  in  the  English  .Laws,  denotes  a  natu- 
ral fool,  a  person  who  hath  had  no  understanding 
from  his  birth." 

"■A  person  who  has  understanding  enough  to 
measure  a  yard  of  cloth,  number  twenty  right- 
ly, and  tell  the  days  of  the  week,  his  parents, 
his  age,  &c.  is  not  an  idiot  in  the  eyes  of  the  law."* 

Idiotism  is  not  always  congenital :  it  may  arise 
from  accident,  as  blows  on  the  head  ;  or  it  may  be 
the  consequence  of  mania,  either  arising  from  ill- 
treatment,  or  as  the  natural  consequence  of  the  dis- 
ease. Excessive  joy  or  sudden  fear  may  produce 
it,  without  previous  mania.  As  an  instance  of  its 
arising  from  excessive  joy,  we  have  the  case  of 
iC  an  engineer,  who  proposed  to  the  committee  of 
public  safety  in  the  2d  year  of  the  republic,  a  pro- 
ject for  a  new  invented  cannon,  of  which  the  effects 
would  be  tremendous.  A  day  was  fixed  for  the  ex- 
periment at  Meudon;  and  Robespierre  wrote  to  the 
inventor  so  flattering  a  letter,  that,  upon  perusing 
it,  he  was  transfixed  motionless  to  the  spot :  he  was 
shortly  afterwards  sent  to  Bicetre  in  a  state  of 
complete  idiotism. "f 

As  an  instance  of  fear  suddenly  producing  idiot- 
ism, we  extract  that  cited  by  Pinel.  "  Two  young 
conscripts,  who  had  recently  joined  the  army,  were 
called  into  action  ;  in  the  heat  of  the  engagement 

*  Dr.  Rees'  Encyclopedia,    f  Pinel  on  Insanity,  p.  167. 


3.5 

one  of  them  was  killed  by  a  musket  ball  at  the  side 
of  his  brother — the  survivor,  petrified  with  horror, 
was  struck  motionless  at  the  sight :  some  days  after- 
ward, he  was  sent  in  a  state  ofeomplete  idiotisrq  to 
his  father's  house.  His  arrival  produced  a  similar 
impression  upon  a  third  son  of  the  same  family." 

The  specific  character  of  Idiotism,  is  a  "total  or 
partial  obliteration  of  the  intellectual  powers  and 
affections,  universal  torpor,  detached  half-articu- 
lated sounds,  or  entire  absence  of  speech,  from  want, 
of  ideas!  in  some  cases,  transient  and  unmeaning 
^gusts  of  passiGJi.*" 

A  very  good  ^dea  of  an  idiot,  may  be  gathered 
from  the  following  strongly  marked  case. 

"  On  a  first  view  of  this  idiot,  what  appears  most 
striking  is  the  extremely  disproportionate  estent 
of  the  face,  compared  with  the  diminutive  size  of 
the  cranium.  No  traits  of  animation  are  visible  in 
his  physiognomy.  Every  line  indicates  the  most 
absolute  stupidity.  Between  the  height  of  the  head 
and  that  of  the  whole  stature,  there  is  a  very  great 
disproportion.  The  cranium  is  greatly  depressed 
hoth  at  the  crown  and  at  the  temples.  His  looks  are 
heavy  and  his  mouth  wide  open.  The  whole  extent 
qfhis  knowledge  is  confined  to  three  or  four  confused 
ideas,  and  that  of  his  speech  to  as  many  inarticu- 
late sounds.  His  capacity  is  so  defective,  that  he 
can  scarcely  guide  his  food  to  the  mouth  ;  and  his 
insensibility  so.great,  that  he  is  incapable  of  attend- 
ing to  the  common  calls  of  nature.  His  step  is  fee- 
ble, heavy  and  tottering.  His  disinclination  to  mo- 

*  Pinel  en  Insanity,  p.  172. 


36 

tion  is  excessive.  He  is  totally  insensible  to  the 
natural  propensity  for  reproduction; — a  passion  so 
strong  even  in  the  Cretin,  and  which  gives  him  a 
deep  consciousness  of  his  existence.*  This  equi- 
vocal being,  who  seems  to  have  been  placed  by  na- 
ture, on  the  very  confines  of  humanity,  is  the  son 
of  a  farmer,  and  was  brought  to  the  hospital  de 
Bicetre  about  two  years  ago.  He  appears  to  have 
been  impressed  from  infancy  with  the  above  cha- 
racters of  fatuity.,'f 

The  feigning  of  idiotism  is  not  so  frequently  at- 
tempted as  that  of  other  complaints.  It  is  too  dif- 
ficult to  be  imitated,  sufficiently  well,  to  deceive  a 
scrutinizing  eye,  and  the  length  of  time  required  to 
effect  this  kind  of  imposition,  is  generally  too  te- 
dious to  answer  ordinary  purposes.  The  assump- 
tion of  it  however,  is  occasionally  met  with  when 
the  intention  is  good,  but  much  more  frequently 
when  it  is  criminal. 

The  well  known  instance  of  Junius  Brutus,  has 
already  been  noticed ;  and  another  singular  in- 
stance which  may  be  mentioned,  occurred  a  few 
years  since.  A  sailor,  on  board  an  American  ves- 
sel, saw  a  boat  from  a  British  man  of  war  approach- 
ing his  ship,  with  the  intention,  as  he  supposed,  of 
pressing  men.  Having  no  protection,  he  intimated 
to  the  captain  his  design,  and  resolved  to  feign 
idiotism,  as  the  best  expedient  for  escaping  im- 
pressment.    The  men,  according  to  custom,  were 

*  For  an  account  of  the  Cretins,  see  Fqdere  on  the  Goitre  and  Cretinge—  also. 
Cox's  Travels  in  Switzerland. 
Y  Pinel  on  Insanjtj,  p.  126. 


37 

all  called  aft.     This  man,  however,  unmindful  oi 
the  orders,  remained  forward,  imitating  the  actions 
of  an  idiot.     The  lieutenant  of  the   English  ship, 
after  calling  to  the  man  a  number  of  times,  asked 
the  captain  who  he  was.     "  O,"  said  the  captain, 
"  a  common  fool,  whom  we  received  from  the  last 
ship  that   boarded   us."     "  A  fool !  ha,"  says  the 
lieutenant,  "  I  have  seen  such  fools  before — come 
here,  and  I  will  fool  you."  Without  difficulty  they 
got  him  into  the  boat,  together  with  two  or  three  of 
his  companions.     He  immediately  took  the  tiller, 
still  continuing  his  grimaces.     When  they  arrived 
at  the  ship,  he  ascended  its  side  with  great  activity, 
ran  up  to  the  captain,  grasped  a  button  of  his  coat, 
pulled  it  off,  and  ran  about  the  deck  looking  at  it, 
and  laughing  with  great  vacancy  of  countenance. 
In  short,  he  acted  his  part  so  well,  that  he  was  or- 
dered back  to  his  own  ship,  and  thus  completely 
effected  his  object. 

Idiotism  is  so  commonly  feigned  for  criminal 
purposes,  that  the  memory  of  almost  every  person 
can  furnish  examples,  those,  however,  who  may 
wish  to  read  cases  of  the  kind  are  referred  to  Chil- 
ly's Criminal  Law  and  East's  Crown  Law. 

Mendicants  are  sometimes  detected,  pretending 
idiotism,  with  the  view  of  exciting  pity,  and,  per- 
haps less  frequently,  of  obtaining  an  asylum  which 
will  preserve  them  from  want,  and  free  them  from 
labour. 

If  an  individual  is  suspected  of  feigning  idiotism, 
and  we  can  discover  that  it  is  congenital,  such  evi- 
dence is  sufficient  to  remove  all  doubt,  and  effect- 
ually to  shelter  him  from  accountability. 


38 

if  we  can  prove  itexisted,  even  a  short  time  before 
the  person  could  possibly  be  aware  that  he  would 
be  benefited,  by  being  considered  deficient  in  in- 
tellect, it  will  be  of  material  assistance  to  us  in 
forming  our  opinion  as  to  its  reality. 

If  we  can  discover  any  satisfactory  cause,  which 
gave  rise  to  this  suspected  derangement,  and  the 
common  characteristics  of  idiotism  are  present^ 
we  are  then  compelled  to  decide  in  favour  of  the 
accused. 

It  is  impossible  to  give  an  adequate  description 
of  that  peculiar  cast  of  countenance,  which  idiots 
possess;  but  any  person,  who  has  been  in  the  habit 
of  seeing  many  of  them,  cannot  well  be  deceived 
after  an  attentive  observation  of  their  actions,  as 
well,  while  they  know  they  are  watched,  as  at  times 
when  they  are  unconsciousof  it  This  is  also  a  means 
upon  which  we  place  much  dependance ;  and  these 
circumstances,  in  the  generality  of  cases,  which  may 
come  under  our  consideration,  will  be  found  suffi- 
cient, to  enable  us  to  form  a  correct  opinion, 

ENCHANTMENTS  AND  DEMONIACAL 

POSSESSION. 

Pretensions  to  these  powers,  ought  to  be  regard- 
ed because  they  have,  sometimes,  attracted  the 
attention  of  physicians,  and  are  those  which  will 
next  be  noticed. 

In  those  countries,  where  the  light  of  science 
does  not  appear  as  yet  to  have  banished  the  dark- 
ness of  superstition,  enchantment  and  demoniacal 
possession,  are  pretended  either  with  the  intention  of 


39 

concealing  crime,  or  extorting  money  ;  or,  perhaps 
more  frequently,  merely  to  excite  the  wonder  and 
astonishment  of  the  more  credulous  portion  of  our 
race.  It  is  not  long  since  persons,  reputed  to  be 
possessed,  gained  almost  a  perfect  ascendancy  over 
mankind,  and  were  considered  by  many,  as  next  to 
the  Deity  in  point  of  power.  To  prove  it,  we  need 
only  refer  to  the  histories  of  Europe,  in  those  dark 
ages  when  superstition  governed  half  the  world. 
Even  as  late  as  the  fifteenth  century,  witchcraft 
was  a  passport  for  mendicants,  and  a  safeguard  for 
criminals. 

De  Haen,  mentions  the  case  "  of  a  woman,  who 
in  consequence  of  attestations,  given  in  her  favour 
by  certain  well-informed  Ecclesiastics,  passed  for 
a  demoniac,  and  who,  after  her  admission  into  the 
hospital  at  Vienna,  was  convicted  of  imposture." 

Dr.  Andrew  Boord,  in  his  "  Extravagantes"  re- 
lates the  method  of  curing  demoniacs  in  his  time* 
They  were  carried  from  all  parts  of  Europe,  to  St. 
Peter's  at  Rome—"  For,"  says  our  author,  "within 
the  precynct  of  St.  Peters  church,  without  St  Pe- 
ters chapel,  standeth  a  pyller  of  whyte  marble^ 
grated  round  about  with  iron,  into  the  whiche  our 
Lorde  jesus  Christe  dyd  lye  himselfe  in  his  way 
unto  the  Pylates  hal,  as  the  Romaynes  doth  say ; 
to  the  whiche  Pyller  al  those,  that  be  possessed  of 
the  devyl,  out  of  divers  countreys  and  nacions,  be 
brought  thyther ;  and  as  they  say  of  Rome,  such 
persons  be  made  there  whole." 

He  relates  the  case  of  a  woman,  who  was  brought 
from  Germany,  and  who  required  more  than  twenty 


40 

men  to  put  her  into  this  pillar,  and  she  was  cured* 
after  the  priest  had  repeated  a  few  sentences  to 
her.  He  conceives  the  efficacy  of  the  cure  "  d yd 
rest  in  the  vertue  that  was  in  the  pyller,  or  els  in 
the  wordes  that  the  Preeste  dyd  speake."  He  ap- 
pears rather  inclined  to  think  it  consisted  in  the 
words  of  the  priest. 

Zacchias  and  Fidelis*  wrote  much  upon  this  sub- 
ject, and  firmly  believed  in  the  power  of  magic. 

Zittmann  seriously  asks  the  question, whether  the 
death  of  many  legitimate  children,  who  die  under 
three  years  of  age,  is  not  to  be  ascribed  to  the 
power  of  witchcraft. 

Alberti  makes  frequent  mention  of  contracts 
with  the  devil. 

Gabr.  Clauder  mentions  a  certain  "  Empusa" 
as  one  prostituted  to  the  devil,  whom  the  faculty  of 
Leipsic  discovered  to  be  in  reality  a  maniac. 

Paracelsus,  whose  visionary  opinions  are  almost 
forgotten,  supposed  that  the  devil  entered  us  bodily, 
much  in  the  same  way  as  a  maggot  does  afiibtrt. 

Even  in  countries,  where  science  receives  its  most 
solid  support,  and  where  it  shines  with  the  great- 
est splendour,  there  are  still  found  those  whose  cre- 
dulity and  superstition  lead  them  to  believe  in  the 
power  of  magic.  And  we  have  not  been  a  little 
surprised,  when  we  have  witnessed  men  of  learning, 
and  whose  education  should  have  taught  them 
better,  countenancing  this  species  of  imposition. 


x  "  Fort.  Fidelis  et  Zacchias  sont  excusables  d'avor  cruau  pouvoir,  ofogiquei 
at  partage,  les  opinions  de  leurs  coutemporahis."    Ballard. p.  4G1 . 


41 

It  is  a  fact,  well  known,  that  there  are  many 
Fortune-tellers  now  traversing  this  country,  in  all 
directions,  imposing  upon  the  credulous,  and  ma- 
king them  believe  they  can  reveal  the  hidden  mys- 
teries of  futurity.  It  is  no  less  astonishing  than 
true,  that  the  famous  one  now  living  between 
Albany  and  Schenectady,  in  this  states  is  resorted 
to  by  both  sexes,  who,  having  lost  a  horse,  covv,  or 
any  other  property,  apply  to  this  woman  that  they 
may  know  where  to  find  it.  Numerous  and 
strange  stories  are  related  of  her,  in  which  she  is 
said  to  have  given  correct  information. 

The  subject  of"  Haunted  Houses"  has  been 
within  a  few  years,  three  or  four  times  discussed 
in  the  civil  courts  of  this  city.  Tenants  have  moved 
out  of  their  houses,  and  refused  to  pay  the  stipula- 
ted rent,  alleging  their  houses  were  haunted,  and 
consequently  untenantable.  In  one  case  the  land- 
lord brought  an  action  for  damages  against  his  te- 
nant, for  reporting  his  house  was  haunted,  whereby 
the  landlord  conceived  the  value  of  his  house  was 
materially  injured.  More  instances  of  the  kind 
might  be  referred  to,  but  those  already  noticed  are 
enough  to  cause  every  well-informed  citizen  to 
blush. 

I  shall  not  pretend  to  argue  the  question  as  to 
the  "  reality  of  Demoniacal  possession ;"  I  shall 
only  remark  that  it  is  disputed  by  men  equally 
eminent  for  their  piety  and  their  talents,  and  shall 
conclude  this  subject,  in  the  words  of  a  French  au- 
thor whom  I  have  already  had  occasion  to  quote. 

6 


42 

i£  II  est  superflu  de  rappeler  qu'elles  ne  merit  erii 
accurse  attention,  de  la  part  de  tribunaux." 

EPILEPSY, 

Having  spoken  of  the  various  forms  of  insanity* 
and  having  made  a  few  observations  upon  Incan- 
tations and  Demoniacal  possession,  the  next  sub- 
ject we  shall  notice,  is  that  of  Epilepsy,  which  is 
the  disease  more  commonly  feigned  in  prisons, 
hospitals,  and  work-houses,  and  principally  with 
the  view  of  being  liberated  from  a  temporary  pun- 
ishment,* or  of  being  exempted  from  labour.  It 
is  also  pretended  by  mendicants,  for  purposes 
which  we  have  already  noticed.  In  the  army  and 
the  navy,  it  is  frequently  met  with,  and  often  occa- 
sions the  physician  a  great  deal  of  trouble.  Mr, 
Keed  mentions,  that  epilepsy  was  very  frequently 
feigned  among  the  soldiers  in  the  West  Indies,  in 
the  year  1790. 

Epilepsy,  is  a  disease,  which  is  noticed  by  the 
Oldest  writers  on  medicine ;  and  the  moderns  seem 
to  have  added  but  very  little  to  the  description? 
given  of  it  by  Hippocrates,  Galen,  Celsus  and 
Aretaeus.  Hippocrates  described  it  under  the  name 
of  V"  »*«»,  the  sacred  disease.  Celsus  calls  it 
majorum  morbum — Galen,  morbus  kerculeus—-" The 
sacred  writers,"  says  Van  Sweten,"  have  called 
epileptic  persons  ^wWo^m  lunatic ;  and  what  is 

*  Ithas  occasionally  happened,  that  prisoners  in  the  New-York  State  Prison,  when 
guilty  of  misdemeanor,  have  been  confined  in  the  cells — they  have  procured  their 
liberation  by  pretending  a  paroxysm  of  epilepsy. 


said  of  the  symptoms  of  the  disease,  confirms  this  as- 
sertion :  for  that  wretched  boy  whom  our  Saviour 
cured,  had  laboured  under  this  disease  from  his  in- 
fancy ;  he  had  fallen  both  into  the  fire  and  water, 
had  lost  his  speech  and  hearing,  he  presently  roared 
out,  as  soon  as  he  fell  down,  foamed  at  the  mouth, 
grinded  his  teeth,  &c.  all  which  symptoms  accom- 
pany the  epilepsy.  But  as  this  disease,  at  its  first 
beginning,  frequently  seizes  the  person  in  the  night 
time,  and  about  the  change,  and  the  full  of  the  moon, 
frequently  rages  with  repeated  attacks ;  hence  they 
seem  to  have  attributed  it  to  the  moon,  which  is 
also  mentioned  by  Aretseus." 

It  is  not  surprising,  in  those  days,  when  the 
knowledge  of  men,  respecting  the  animal  economy 
was  so  very  limited,  that  this  disease  should  have 
been  ascribed  to  demons,  divine  wrath,  incanta 
tions  and  the  like  supernatural  causes* 

Boerhaave  defines  epilepsy  thus — "  the  person 
suddenly  falls  down,  losing  all  the  senses  both  ex- 
ternal and  internal,  with  a  violent,  involuntary,  re- 
ciprocal, concussion  of  all  the  muscles,  or  of  some 
of  them,  with  an  alternate  relaxation  and  a  return- 
ing paroxysm.* 

A  paroxysm  of  true  epilepsy,  is  marked  by  the 
following  symptoms.  The  person  is  sometimes 
suddenly  thrown  down,  without  any  previous 
warning,  in  a  state  of  violent  convulsions,  but  most 
frequently f  previous  to  the  attack,  he  feels  a  swim- 

*  Sect.  1071 — Van  Sweten  Commentaries  on  Boerhaave. 

t  Dr.  Thomas  thinks,  the  premonitory  symptoms  of «        'sy-m,  occur  much  !c-c.s 
frequently,  thaa  an  attack  of  epilepsy  without  them. 


|Mifg  in  bis  bead,  and  perceives  sparks  before  bis 
eyes,  or  an  appearance  like  a  rainbow,  and  fancies 
be  hears  strange  sounds.  Others  are  sensible  of  a 
disagreeable  smell,  or  an  unpleasant  taste  in  the 
mouth.  Some  perceive  a  cloud  before  their  eyes, 
and  every  object  appears  enveloped  in  a  mist. 
Sometimes,  the  first  warning  of  an  attack,  is  the 
sensation  of  a  cold  blast  ascending  from  the  lower 
part  of  the  body,  and  as  soon  as  it  arrives  at  the 
heart,*  the  patient  is  suddenly  deprived  of  all  sen- 
sation, and  falls  down  in  convulsions.  This  sensa- 
tion of  cold  air,  is  the  "  aura  cpileptica"  of  authors. 
Most  patients,  the  moment  they  fall,  groan  or  cry 
out,  in  a  distressing  manner. 

The  convulsions  which  immediately  follow  these 
symptoms,  differ  in  degree,  duration,  and  appear- 
ance in  different  epileptics*  The  forehead  and 
hairy  scalp  are  sometimes  strongly  convulsed — the 
hair  raised,  and  the  eye-brows  depressed,  as  in  a 
person  in  a  fit  of  anger,  the  eyes  appearing  fixed* 
stern  and  prominent — The  eye-lids  are  sometimes 
strongly  convulsed,  and  again,  only  a  tremulous 
motion  is  perceived ;  in  some  epileptics  they  are 
quite  closed,  and  in  others  again  they  remain  half 
open,  exhibiting  between  them  the  white  of  the  eye. 
The  muscles  of  the  face  are  strongly  convulsed, 
and  all  the  passions  are  expressed  in  very  quick 
succession.  The  mouth  sometimes  remains  wide 
open,  and  the  jaws  have  been  known  to  be  dislo- 
cated.  The  tongue  is  often  thrust  out  of  the  mouth 

*  Dr.  Thomas  says  it  ascends  to  the  head  before  sensation  is  lost.    . 


43 

and  crowded  between  the  teeth  ;  it  seldom  escapes 
being  wounded,  during  a  paroxysm,  and  occasion- 
ally, a  piece  of  it  is  bitten  completely  off.  When 
this  happens,  blood  is  ejected  from  the  nose  and 
mouth,  sometimes  mixed  with  a  viscid  foam.  In 
some  instances,  though  but  very  few,  blood  is  dis- 
charged from  the  ears.  A  grinding  of  the  teeth  is 
generally  heard,  and  so  powerful  is  the  spasm> 
"  that,"  says  Van  Sweten,  "  I  remember,  not  with- 
out horror,  to  have  seen  pieces  of  the  grinders 
broken  off."  Sometimes  the  head  is  bent  forward, 
and  the  lower  jaw  presses  upon  the  breastbone. 
At  other  times,  it  is  bent  backward,  between  the 
scapula? ;  and  again  it  is  astonishingly  rotated., 
The  fists  are  usually  clenched,  and  the  arms  and 
legs,  affected  with  violent  convulsions,  belcbings, 
rumbling  of  the  bowels,  vomiting,  and  an  involun- 
tary discharge  of  the  fceces  and  urine,  are  also 
symptoms  of  this  disease.  The  pulse,  at  the  com- 
mencement of  the  paroxysm,  is  quick  and  small; 
and  at  its  termination  is  fuller,  more  languid,  and 
slow.  The  respiration  is  much  disturbed,  and  ap- 
pears as  in  a  person,  who  is  in  danger  of  being  suffo- 
cated. A  noise  is  also  made  similar  to  that  of  a 
man  attempting  to  lift  a  heavy  burden, 

The  blood,  not  finding  an  easy  passage  through 
the  lungs,  the  right  ventricle  becomes  surcharged, 
the  veins  of  the  neck  and  forehead  become  dis- 
tended, and  the  face  assumes  a  livid,  frightful  ap- 
pearance. 

About  this  time,  a  tenacious  foam  is  discharged 
from  the  nose  and  mouth,  and  appears  to  indicate 


46    . 

the  acme  of  the  paroxysm,  for,  from  this  lime,  the 
symptoms  abate ;  the  countenance  grows  more 
natural ;  the  breathing  appears  less  oppressive,  but 
is  still  a  little  stertorous,  resembling  the  respiration 
of  those  affected  with  apoplexy.  When  sensation 
begins  to  return,  the  limbs  of  the  patient  are  torpid 
—he  feels  either  a  heaviness  in  his  head,  or  else,  a 
dull  pain ;  his  countenance  is  pale,  and  he  is  pusil- 
animous  and  melancholy  from  the  fatigue,  and 
shame  attending  the  disease. 

To  shew  to  what  a  degree,  an  imitation  of  these 
symptoms  may  be  carried,  and  how  difficult,  from 
observation  alone,it  must  be,to distinguish  between 
the  true  and  the  false  disease,  the  following  cases, 
which  occurred  in  the  New-York  State  Prison,  are 
subjoined. 

A  black  girl,  about  twenty-two  years  of  age,  for 
some  misdemeanour,  was  confined  in  the  Cells.  Af- 
ter about  two  or  three  hours  had  elapsed,  1  was 
called  upon  to  visit  her,  in  an  "  epileptic  fit"  as  I 
was  informed.  I  found  her  resting  upon  her  head 
and  heels,  her  eyes  closed,  and  her  eye-lids,  and  the 
muscles  of  her  face,  convulsively  agitated,  her 
breathing  laborious,  her  fists  clenched,  and  her 
limbs  so  stiff,  as  to  baffle  my  greatest  efforts  to 
bend  them.  Her  pulse  was  quick,  but  not  very 
small.  With  these  symptoms,  she  also  had  a  foam- 
ing at  the  mouth.  This  condition  of  things  lasted 
about  ten  minutes,  after  which  a  general  relaxation 
took  place,  but  her  eye-lids  still  continued  closed 
and  quivering  :  in  attempting  to  examine  the  state 
of  the  pupils,  I  found  them  turned  so  far  back  as  to 


prevent  my  getting  a  view  of  them  ;  and  it  should 
be  noticed,  that  this  hiding  of  the  pupil  was  a  very 
common  circumstance  with  those  prisoners  who 
endeavoured  to  mimic  epilepsy.  Upon  applying 
any  sternutatories,  she  renewed  the  convulsions ; 
and  when  I  attempted  to  administer  an  antispas- 
modic, I  found  her  teeth  so  fixed  together,  that 
every  endeavour  was  fruitless. 

In  this  state  of  things,  I  threw  nearly  a  bucket 
of  water  over  her,  but  it  appeared  only  to  aggra- 
vate the  symptoms,  for  it  was  immediately  followed 
by  violent  agitation,  so  that  much  force  was  requir- 
ed to  confine  her.  After  thfe  more  violent  convul- 
sive actions  had  ceased,  but  whilst  a  rigid  state  of 
the  limbs  still  continued,  she  was  directed  to  be 
carried  to  her  bed.  Those  who  were  carrying  her, 
were  ordered  to  raise  her  about  four  feet  from  the 
floor,  and  were  then  directed,  in  a  loud  voice,  to 
"let  her  drop."  She  instantly  endeavoured  to 
preserve  herself  from  injury,  and  fell  upon  her 
feet.  Finding  the  deception  was  manifest,  she  com- 
menced beating  those  persons  who  had  let  her  drop. 

Not  two  weeks  had  passed,  before  she  was  again 
committed  to  the  cells,  and  in  a  short  time,  I  was 
requested  to  visit  her  in  another  "  fit."  The  symp- 
toms attending  it,  were  much  the  same  as  those  be- 
fore mentioned,  except  that,  from  her  nose  and 
mouth  issued  a  bloody  froth ;  the  convulsions  did 
not  appear  so  strong,  and  her  breathing  resembled 
more  the  apoplectic  stertor.  Sternutatories  ap- 
peared to  have  no  effect  upon  her. 

I  called  the  keeper,  Mr,  Raven,  into  the  hall  of 


48 

Ibe  cells,  and  told  him,  in  aloud  voice,  so  that  the 
woman  might  hear  me,  that  "I  believed  now,  she 
liad  a  real  fit ;  that  she  had  not  before  suffered  so 
much  pain  without  flinching,  and  that  I  would  give 
directions  to  the  f  principal  keeper5  to  have  her 
taken  out  of  the  cells."  In  a  low  whisper,  I  then  di- 
rected hinx,  to  lock  her  door,  leave  me  in  the  hall, 
and  lock  the  other  doors  ;  and  desired  him  to  come 
up  again  in  a  few  minutes,  without  making  any 
noise.  I  placed  myself,  at  the  little  window  in  the 
door  of  her  cell,  in  order  to  observe  ber  move- 
ments ;  but,  no  sooner  had  Mr.  Haven  secured  the 
second  door,  than  she  raised  herself  up,  looked 
around  with  an  indescribable  kind  of  exultation  in 
her  countenance,  as  if  to  say,  £  I  have  now  con- 
quered them.  In  a  few  moments  I  shall  have  to 
act  the  second  part  of  my  farce,  and  be  restored  to 
my  bed."  She  examined  her  bread,  and  the  cann  of 
water,  from  which  she  drank,  and  covered  her  feet 
and  legs,  which  were  cold,  from  being  exposed  to 
the  air.  About  this  time,  she  caught  my  eye  at  the 
little  window,  and  instantaneously,  as  if  by  ae 
electrical  shock,  she  fell  back  in  another  fit.  I 
then  told  her,  I  should  leave  her  to  act  fits,  or  to 
amuse  herself  in  any  way  she  might  think  proper, 
for  I  was  now  fully  convinced,  that  she  only  in- 
tended to  deceive  me.  Another  case  must  answer 
our  present  purpose. 

A  black  girl,  about  twenty-one  years  of  age, 
was  frequently  the  subject  of  convulsions.  The 
paroxysm  in  this  person,  differed  from  the  ordina- 
ry kind,  from  the  circumstance  of  her  mO/Uth  being 


stretched  wide  open.  When  I  was  requested  to 
see  her,  which  was  about  the  middle  of  the  night, 
the  convulsions  were  apparently  very  violent,  her 
eyes  closed,  and  her  eye-lids  and  the  muscles  of  her 
face  quivering ;  her  pulse  was  full  and  frequent, 
but  not  hard  ;  her  skin  of  a  natural  temperature^ 
and  covered  with  perspiration.  Under  these  cir- 
cumstances, I  did  not  long  hesitate,  but  adminis- 
tered to  her  a  powerful  antispasmodic  dose.  I  took 
Tinct.  Opii.  3ij.— Tinct.  Assaf.  3ss.  Aq.  Amon. 
gss^-Aq.  Com.  3J.— of  which  1  gave  her  immedi- 
ately one  table-spoonful,  by  holding  her  nose  and 
pouring  it  into  her  mouth.  This  occasioned  a  vi- 
olent and  instantaneous  cough,  by  which  nearly  the 
whole  of  what  she  had  taken  was  rejected.  It, 
however,  had  the  desired  effect,  for  she  having 
heard  me  say,  that  I  should  repeat  the  dose  every 
five  minutes,  until  she  "  closed  her  mouth,  opened 
her  eyes,  and  stopped  kicking,"  concluded  it  was 
her  best  policy,  to  exhibit  the  required  signs  of 
health  as  soon  as  possible  ;  and  accordingly  in  not 
more  than  five  minutes,  she  was  as  sensible,  and  as 
well  as  any  one  in  the  room.  After  making  her 
promise,  that  she  would  not  disturb  me  again  that 
night,  I  left  her. 

I  have  frequently  seen  the  tongue  so  much  bit- 
ten, that  a  considerable  quantity  of  blood  has  been 
discharged  from  the  nose  and  mouth;  and  to  en- 
deavour the  more  to  weaken  our  suspicions,  these 
impostors  have  even  gone  so  far  as  to  draw  blood 
from  their  ears,  by  wounding  them  with  pins.  At 
one  time,  the  half  of  a  pin  thus  introduced,  was, 

7 


ad 

with  difficulty  extracted.  Their  bodies  have  beets 
much  bruised  by  beating  against  the  bedstead,  the 
floor,  or  the  wall.  They  have  resisted  the  most 
powerful  sternutatories,  and  have  endured  astonish- 
ing degrees  of  pain.  Their  features  have  been  dis- 
torted in  such  a  manner,  that  a  common  observer 
would  be  convinced  of  the  existence  of  disease: 
their  eyes  are  often  rolled  so  far  back,  as  almost 
Completely  to  conceal  the  cornea :  fatigued,  per- 
haps, by  their  exertions  after  all  these  appearan- 
ces of  disease,  they  have  suddenly  opened  their 
eyes  and  "laughed  me  full  in  the  face." 

These  facts  are  sufficient  to  show  that  there  are 
few  symptoms  in  epilepsy  which  may  not  be  coun- 
terfeited. They  also  tend  to  show  the  caution 
every  physician  should  exercise  before  giving  an 
opinion,  and  prove  that  we  can  best  rely  upon 
experiment  in  distinguishing  between  the  mere  imi- 
tator, and  the  really  afflicted  :  and  here  our  tests 
are  chiefly  to  be  directed  to  discover  the  presence 
of  sensation.  Knowing  that  in  true  epilepsy,  all 
sensation  is  lost,  we  may  rest  confident,  if  the  re- 
quired signs  are  present,  the  disease  cannot  exist. 
The  tests  which  ha\e  been  employed  are  many. 
Yan  Sweten  mentions  the  case  of  "a  young  noble- 
man of  a  naughty  disposition,  who,  if  his  parents 
denied  him  any  gratification  he  wanted,  immedi- 
ately counterfeited  this  complaint;  when  the  doctor 
was  called,  he  ordered  a  surgeon  to  touch  his  great 
toe  with  a  hot  iron,  upon  which  he  immediately 
jumped  up,  and  being  afterwards  given  to  under- 
stand, that  upon  the  next  paroxysm,  the  cautery 


•51 

must  be  applied,  he  never  durst  counterfeit  the 
disease  any  more."* 

While  there  are  some  cases,  which  may  be  de- 
tected in  this  way,  there  are  others  which  foil 
every  attempt  at  discovery.  JJe  Haen  mentions 
the  case  of  a  woman  who  feigned  epilepsy,  and  sub- 
mitted to  the  actual  cautery  without  detection,  and 
who,  afterwards  being  condemned  to  death,  con- 
fessed that  she  had  been  practising  a  deception, 
To  account  for  this,  we  must  remember,  that  the 
strength  of  resolution  is  very  great,  and  that  to  ac- 
complish a  favourite  design,  the  severest  pains  can 
be  endured-  Even  a  trifling  object,  has  command- 
ed a  resolution  which  is  astonishing.  I  knew  an 
instance  of  a  young  man  who  had  declared  that  he 
could  not  be  made  to  stir  by  pinching  his  ear.  The 
experiment  was  made ;  and  a  person  present  actu- 
ally removed  a  portion  of  the  helix  without  the  in- 
dividual manifesting  any  signs  of  feeling,  except- 
ing that  of  a  few  tears. 

Let  us,  also,  refer  to  the  histories  of  those  per? 
sons  who  suffered  themselves  to  be  burned  to  death, 
rather  than  renounce  their  faith,  and  if  the  histo- 
ries be  correct,  we  shall  see  that  some  of  them 
were  scarcely  moved. 

The  Hindoos  are  noted  for  the  strength  of  their 
resolutions.  Instances  are  related  of  their  closing 
their  fists,  and  resolving  never  to  open  them,  and 
they  conceive  their  vow  so  sacred,  that  they  suffer 
the  nails  to  grow  through  the  hand.     They  some- 


*  Vol,  10,  p,  329, 


times  clasp  their  hands  together,  and  place  them 
mpon  their  heads,  resolving  never  to  remove  them. 
The  consequenceis, their  arms  either  inflame,  swells 
and  mortify,  or  they  wither ;  and  their  resolution 
remaining  firm  to  the  last.  Women  mount  the 
funeral  piles  of  their  husbands,  and  because  signs 
pf  sensation  are  considered  as  a  want  of  faith,  they 
are  seldom  seen  to  stir.^ 

But  we  need  not  go  so  far  for  proofs  of  the 
strength  of  resolution,  for  if  we  call  to  mind  the 
cases  of  those  patients  who  have  undergone  the 
severest  operations,  without  exhibiting  the  smal- 
lest signs  of  feeling,  we  must  be  convinced,  that  an 
apparent  loss  of  sensation,  is  often  a  very  equivo- 
cal circumstance  by  which  to  direct  our  judg- 
ment.! 

In  order,  however,  to  discover  the  presence  of 
sensation,  other  means  than  those  we  have  men- 
tioned have  been  employed.  Van  Sweten  says, 
there  is  no  difficulty  attending  the  detection  ; 
"  for  if  you  pinch  the  arm  with  the  fingers  while 
feeling  the  pulse,  it  will  always  discover  itself." 
Putting  the  fingers  in  the  mouth,  and  pressing  the 
gums  with  the  nails— running  pins  and  needles  un- 
der the  finger  nails— and  pressing  the  nails  from 
the  skin,  have  detected  many  cases.  Dashing  a 
bucket  of  cold  water  over  the  patient,  at  the  com- 


*  Much  curious  and  interesting  matter,  upon  this  subject,  may  be  seen  in  the 
Sketches  of  the  Hindoos  by  an  anonymous  writer,  published  in  London — Also,  in 
the  Asiatic  Annual  Register. 

f  Last  winter,  I  saw  a  girl  about  17  years  of  age,  in  Guy's  Hospital,  London,  suf- 
fer her  thigh  to  be  amputated,  without  exhibiting  the  smallest  symptom  of  pain,  and 
during  the  greatest  part  ef  the  operation,  a  pleasant  smile  was  on  her  countenance. 


53 

aiencement  of  a  paroxysm,  will  often  cause  a  change 
of  symptoms.  These  are  some  of  the  means  which 
have  been  employed  to  detect  feeling.  4 

The  dilatation  of  the  pupil  is  depended  upon 
by  many  as  a  sure  sign  of  true  epilepsy.  When 
the  pupil  can  be  seen  it  may  influence  our  judg- 
ment, but  we  know,  that  the  eyes  are  often  rolled 
so  far  bacjs  as  to  hide  the  pupil  entirely  ;  and  we 
also  know,  that  by  rubbing  a  little  of  the  Tinet.  of 
Atropa  Bellodona,  or  some  other  of  the  narcotics 
on  the  eye-lids,  they  will  have  the  effect  of  dilating 
the  pupil.  The  faculty  of  Leipsic  declared  a  woman 
to  feign  epilepsy,  because  her  eyes  were  closed 
during  a  paroxysm.  They  paid  the  strictest  atten- 
tion to  the  closing  of  the  eyes,  and  the  sensibility 
of  the  schneiderian  membrane,  and  in  order  to  ascer- 
tain the  state  of  the  latter,  they  made  frequent  use 
pf  sternutatories ;  but  we  have  seen,  that,  even 
these  have  failed  of  detecting  the  imposition,  when 
the  disease  was  feigned.  The  colour  of  the  face 
may  be  made  livid,  and  the  veins  of  the  neck  dis- 
tended, by  holding  the  breath,  which  pretenders 
generally  very  well  understand^  and  very  exactly 
imitate. 

A  story  is  related  of  a  beggar  in  Paris,  who  fre- 
quently feigned  these  fits.  A  person  who  suspect- 
ed the  deception,  proposed  a  bed  of  straw  to  be 
brought  into  the  street,  as  he  stated  to  the  beggar 
to  prevent  his  injuring  himself  by  the  effects  of  the 
fit.  Soon  after  the  bed  was  proposed,  as  was  ex- 
pected, he  had  a  fit  and  fell  on  the  bed.  Fire  was 
immediately  applied  to  the  four  corners  of  the  bed", 
and  the  beggar  jumped  up  and  ran  away. 


54 

A  heavy  shock  of  electricity  is  a  test  of  feigned 
epilepsy,  which  1  have  employed  with  much  sue- 
cess.  I  made  it  a  rule  in  the  prison  as  soon  as 
a  prisoner  had  a  fit,  to  electrify  him  if  practicable* 
By  putting  this  in  practice  for  a  short  time,  the  re- 
sult was,  that  instead  of  being  called  upon  two  or 
three  times  in  twenty-four  hours,  to  prescribe  in 
epilepsy  I  was  not  troubled  as  often  in  a  week. 

Those  who  feign  epilepsy,  seldom  imitate  the 
last  part  of  the  paroxysm  as  well  as  the  first.  The 
stupor  and  sense  of  shame  which  never  fails  to  at- 
tend true  epilepsy,  is  generally  wanting  in  the 
-feigned  disease.  Pretenders  begin  to  foam  at  the 
mouth  as  soon  as  the  paroxysm  commences,  and 
all  have  not  courage  to  bite  their  tongue,  or  as  true 
epileptics  often  do,  close  their  teeth  upon  their 
tongue  and  let  them  remain  so  for  a  longtimea  un- 
conscious of  the  injury  they  are  doing. 

The  convulsive  motions  of  the  muscles  of  the 
face  in  feigned  epilepsy,  are  by  no  means  so 
quick  as  those  of  the  real  disease.  The  tremor  ap- 
pears more  general,  and  not  as  in  true  epilepsy,  in 
particular  parts  of  the  body.  And  this  voluntary 
convulsive  motion  of  the  muscles  of  feigned  epi- 
leptics, may  often  be  stopped  by  suddenly  attract- 
ing their  attention,  as  by  the  cry  of  fire,  or  by  firing 
off  a  squib  close  by  them  when  they  do  not  expect 
it. 

After  this  view  of  the  subject,  I  think,  that  in*. 
stead  of  concluding  with  Yan  Sweten,  that  feigned 
epilepsy  may  be  easily  detected,  we  may  with  more 
correctness  say  with  Ballard,  that  it  is  extremely 
difficult  to  distinguish  it  from  the  real  disease. 


55 
,       HYSTERIA. 

Tfiis  disease  appears  nearly  allied  to  epilepsy  : 
and  as  the  convulsions  are  sometimes  feigned,  m 
boarding  schools  by  young  ladies,  whose  principal 
ambition  is  that  of  being  enabled  to  excuse  them- 
selves from  study,  and  by  females  in  other  situa- 
tions of  life,  in  order  to  excite  compassion,  and  to 
gain  admittance  into  public  charities,  &c.  it  be- 
comes the  duty  of  the  physician  to  distinguish  be- 
tween the  true  and  the  false  disease;  and  this 
duty  is  by  no  means  easy  to  perform.  A  man 
as  well  skilled  in  the  knowledge  of  disease,  and 
possessing  as  much  discernment  as  Dr.  Cullen,  was 
once  deceived.* 

Hysteria  appears  under  so  many  forms,  and  ex- 
hibits so  many  different  characteristics,  that  it  is 
almost  an  impossibility  to  mark  the  limits  of  a  pa- 
roxysm ;  and  to  say  what  symptoms  may  be  ad- 
mitted as  pathognomonic,  and  what  may  not.  This 
disease  is  distinguished  from  epilepsy  by  the  "  glo- 
bus hystericus,  by  the  great  flow  of  limpid  urine, 
by  the  sudden  transition  from  laughing  to  crying, 
and  by  the  fear  of  death  preceding  and  succeeding 
the  paroxysms."f  Cullen  defines  hysteria  to  be 
"  a  murmuring  of  the  bowels  ;  a  sense  of  a  globe 
rolling  itself  in  the  abdomen,  and  rising  to  the  sto- 
mach, and  fauces  producing  strangulation;  sleep, 
convulsions;  a  profuse  discharge  of  limpid  urine; 
the  mind  changeable,  inconstant,  and  not  under  the 
controul  of  the  v*  ill."J 


*  Vide  Male's  Judiciary  or  Forensic  Medicine. 

f  Thomas's  Practice,  p.  "273.  i  Lewis  Cullen,  p.  133, 


5& 

The  means  for  detecting  feigned  hysteria,  being 
the  same  as  those  already  submitted  for  detecting 
feigned  epilepsy,  it  is  unnecessary  to  enter  into  a 
further  discussion  of  the  subject,  and  we  shall  refer 
to  Cullen,  Thomas,  and  Tan  Sweteri  for  a  particu- 
lar description  of  the  symptoms,  after  stating  a  few 
of  the  more  common  causes  of  the  disease. 

The  paroxysms  are  readily  excited  in  those  who 
are  subject  to  them,  by  passions  of  the  mind,  and 
every  considerable  emotion,  especially  when 
brought  on  by  surprise  ;  hence  sudden  joy,  grief3 
fear,  &c.  are  very  apt  to  occasion  them  ;  they  have 
also  been  known  to  arise  from  irritation  and  sym- 
pathy. 

"  Women  of  a  delicate  habit,  and  whose  nervous 
system  is  extremely  sensible,  are  those  who  are 
most  subject  to  hysteric  affections  ;  and  the  habit 
which  predisposes  to  this  attack,  is  acquired  by  in- 
activity and  a  sedentary  life,  grief,  anxiety  of 
mind,  late  hours,  dissipation,  a  suppression  or  ob- 
struction of  the  menstrual  flux,  excessive  evacua- 
tions, and  the  constant  use  of  a  low  diet,  or  a  crude 
unwholesome  food."* 

CATALEPSY. 

Perhaps  this  may  be  as  proper  a  place  as  any  to 
speak  of  catalepsy,  ecstasies  and  trances,  which  are 
commonly  noticed  among  -the  feigned  diseases. 
These  ate  feigned  principally  by  religious  hypo- 
crites, in  order  to  acquire  a  character  of  great  sanc- 
tity. 

*  Thomas's  Practice,  p.  274* 


57 

Zacehias  mentions  the  case  of  a  female,  whom  he 
knew,  who,  when  many  were  collected  together  in 
a  church,  would  become  suddenly  fixed  as  if  in  an 
extasy,  and  remain  in  the  same  posture  for  a  length 
of  time,  sometimes  stretching  herself  forward  in  a 
most  extraordinary  manner,  as  if  about  to  fly;  but 
what  appeared  more  surprising,  was,  that  she  could 
change  the  colour  and  expression  of  her  counte- 
nance to  a  great  degree,  and  very  suddenly ;  some- 
times appearing  quite  red,  and  at  other  times  pale. 
She  eventually  became  a  public  prostitute. 

Catalepsy  is  a  disease  of  very  unfrequent  occur- 
rence in  this  country.  Boerhaave  defines  it  to  be 
"  that  disease  in  which  the  patient  is  immediately 
struck  motionless,  insensible,  and  retains  the  same 
posture  which  he  was  in,  the  very  moment  he  was 
(seized."* 

It  does  not,  however,  appear  to  be  always  at- 
tended with  insensibility ;  for  there  are  cases  re- 
lated, in  which  the  patient  could  speak,  swallow, 
and  move  the  eyes  in  any  direction.  For  a  singular 
case  of  catalepsy,  see  the  Edinburgh  Medical  and 
Surgical  Journal,  Vol.  1,  page  61.  Dr.  Lubboch 
of  Norwich,  there  details  a  case  which,  if  he  has  not 
been  deceived,  is  certainly  a  very  singular  variety 
of  catalepsy. 

Catalepsy  may  be  induced  by  intense  study  and 
strong  emotions  of  the  mind.  Religious  enthusi- 
asts are  frequently  liable  to  it,  and  women  more 
often  than  men,  from  being  predisposed  to  it  by 
greater  irritability  of  constitution. 


*  Aphorism,  1036. 
8 


The  limbs  of  cataleptic  patients  remain  in  what- 
ever situation  they  are  placed.  "  The  vital  actions, 
as  the  pulse  and  respiration,  are  scarcely  changed, 
unless^  that  sometimes  the  pulse  is  observed  to  be  a 
little  weaker,  though  it  does  not  always  happen."* 
Electricity  will  generally  detect  any  pretensions 
to  this  complaint.  The  tests  are  the  same  as 
those  recommended  for  epilepsy.  We  conclude 
pur  observation  by  relating  a  case  of  feigned 
catalepsy. 

A  young  lady  of  Rensselear  county  in  this  state, 
at  the  age  of  fifteen  years,  for  no  assignable  motive, 
(for  she  possessed  many  of  the  comforts  of  life)  was 
induced  to  pretend  she  could  neither  move  or 
speak.  She  was  regularly  lifted  from  her  chair  to 
her  bed  and  back  again3  as  occasion  might  require. 
She  slept  well;  had  a  good  appetite;  her  counte- 
nance looked  healthy,  and  with  the  exception  of  the 
two  symptoms  just  mentioned,  nothing  could  be 
observed  that  had  the  appearance  of  disease.  The 
singularity  of  her  complaint  attracted  the  attention 
of  several  physicians,  and  so  vyell  did  she  act  her 
part,  that  while  some  of  them  understood  the  real 
nature  of  her  complaint,  there  were  others  who 
could  not  be  convinced,  until  an  experiment  put  \t 
beyond  doubt. 

She  possessed  a  terrifying  idea  of  electricity.  It 
was  talked  of  in  her  hearing  as  something  terrible. 
A  machine  for  exciting  it  was  procured,  and  upon 

her  receiving  the  first  shock,  which  was  a  severe 

_r__ j _ — rrv. 

*  Van  Swieten's  Commentaries  on  Aph.  1039, 


59 

tone,  she  spoke  for  the  first  time  in  six  months,  and 
the  more  credulous  part  of  her  friends  concluded, 
a  miracle  had  been  performed.  She  got  well  imme- 
diately, and  is  now  living,  and  enjoysperfect  health* 

PALSY. 

Palsy  is  feigned  in  the  same  situations,  and  for 
the  same  purposes  as  Epilepsy,  though  much  less 
frequently* 

Palsy  is  attended  with  so  many  symptoms  which 
depend  entirely  upon  the  relation  of  the  patient, 
and  so  very  few  external  characteristics, that  the  de- 
tection of  the  feigned  disease  is  always  much  more 
difficult  than  that  of  epilepsy ;  and  let  the  preten- 
der possess  but  little  of  that  firm  resolution  which 
we  have  already  noticed,  I  will  venture  to  say, 
there  are  few  physicians  who  possess  sufficient  dis- 
cernment to  detect  the  fraud. 

Boerhaave  defines  this  disease,  "  a  lax  immobi- 
lity of  a  muscle  not  to  be  overcome  by  any  effort 
of  the  will,  or  of  the  vital  powers :  sometimes  there 
is  an  absolute  insensibility  of  the  part;  sometimes 
a  small  degree  of  feeling  remains,  attended  with  a 
numbness  and  a  pricking  sensation*"* 

It  will  be  adding  very  little  to  our  purpose,  to 
take  a  view  of  the  phenomena  of  this  disease.  It 
may,  however,  be  proper  to  notice  the  more  com- 
mon of  its  causes;  for  if  these  are  present,  there 
will  be  no  necessity  for  a  further  inquiry. 


*  Aphorism  10;"7. 


60 

The  causes  of  palsy  are,  compression  of  the 
nerves,  either  by  tumours  or  injury  done  to  the 
part,  as  blows -upon  the  head  or  spine.  Palay  may 
also  follow  as  the  effect  of  poisons,  as  lead  and  arse- 
nic; or  it  may  be  the  consequence  of  apoplexy  and 
rheumatism.  It  may  be  sudden  or  gradual  in  its 
approach ;  if  gradual,  it  is  preceded  by  numbness, 
coldness  and  paleness,  and  sometimes  by  slight 
convulsive  twitches. 

A  comparison  of  the  symptoms  of  the  real  and 
the  feigned  disease,  will  be  of  very  little  service  in 
detecting  imposition.  We  nave  therefore  to  depend 
chiefly  upon  tests ;  and  the  first  we  shall  recom- 
mend is  that  of  Electricity.  Commence,  by  apply- 
ing light  shocks  to  the  part  affected  ;  then  the  same 
quantity  (graduated  by  an  electrometer)  to  apart 
not  affected,  and  carefully  observe  of  which  the 
patient  complains  most.  If  the  disease  is  real,  the 
patient  will  immediately  remark  a  difference,  the 
shock  passed  through  the  unaffected  part  being 
most  painful,  while  that  through  a  limb  affected* 
creates  a  sensation  rather  pleasant  than  other- 
wise. Shocks  which  are  very  painful  to  bear 
through  a  healthy  limb  are  borne  without  any 
difficulty,  in  one  that  is  palsied.  Therefore,  by 
employing  electricity  (commencing  with  slight  and 
increasing  to  heavy  charges)  if  the  disease  is  real, 
we  are  in  the  use  of  a  good  remedy,  and  if  it  is 
feigned,  we  are  employing  the  best  test  to  discover 
deception. 

.  An  instance  occurred  in  the  New-York  State  Pri- 
son>in  which,  in  this  way,  an  imposition  was  detected. 


SI 

L.  B.  a  Frenchman,  had  been  in  the  hospital  for  six 
or  seven  months,  and  complained  of  inability  to 
bend  his  knee,  and  about  once  in  two  or  three 
weeks,  he  affected  a  fit  of  epilepsy.  He  had  sub- 
mitted to  blisters,  frictions,  cathartics  and  various 
remedies,  but  all  without  success,  and  as  I  strongly 
suspected  fraud,  by  the  unconnected  and  unnatural 
account  he  gave  of  his  complaint,  and  as  he,  was 
rather  of  a  timid  disposition,  I  thought  him  a  very 
fit  subject  for  electricity.  I  began  with  slight 
shocks,  and  about  the  fifth  day  charged  four  hun- 
dred and  fifty  square  inches  of  covered  surface  ; 
upon  receiving  which,  he  immediately  jumped  up5 
ran  into  the  hall  in  a  passion,  asked  for  his  dismis- 
sion, and  resumed  his  work,  which  was  that  of  a 
shoemaker. 

Blisters,  cupping,  the  application  of  setons 
and  issues,  while  they  are  among  the  best  remedies 
for  the  real,  are  also  very  good  ones  for  detecting 
the  feigned  disease.  But  we  sometimes  see  cases 
which  elude  every  attempt  at  detection,  until  the 
object  of  the  individual  is  effected. 

These  imprisoned  pretenders  make  use  of  so  much 
piteous  language,  appeal  so  frequently  to  their 
"  wretched  situation,"  appear  so  anxious  to  obtain 
the  opinion  of  the  physician  respecting  the  proba- 
ble termination  of  their  complaints,  and  these 
whining  interrogations  are  accompanied  with  such 
an  abundance  of  tears,  and  their  conduct  carries 
with  it  the  appearance  of  so  much  plausibility  and 
so  much  misery,  that  it  throws  the  unsuspecting 
physician  completely  off  his  guard,  leaving  him 


62 

scarcely  a  doubt,  as  to  the  reality  of  the  disease.  One 
or  two  cases  will  be  sufficient  to  show  to  what  ex- 
tent they  are  capable  of  carrying  their  deceptions^ 
and  to  prove,  that  there  are  men,  who  would  rather 
endure  the  pain  of  blisters,  scarificators,  setonsand 
issues,  with  a  long  list  of  disagreeable  remedies, 
and  remain  idle,  than  perform  their  regular  and 
easy  tasks. 

T.  B.  a  black  man,  forty  years  of  age,  sentenced 
to  the  State  Prison  for  fifty-six  years,  was  admitted 
into  the  hospital,  after  about  one  year's  confine- 
ment, for  paraplegia.  He  grew  gradually  worse, 
and  after  a  short  time  was  confined  entirely  to  his 
bed.  Blisters,  friction,  electricity,  cupping,  ca- 
thartics, abstinence,  and  a  long  list  of  active  and 
painful  remedies  were  employed,  but  all  without 
effect.  At  length  the  physician  despairing  of  suc- 
cess, and  not  once  suspecting  deception,  classed 
him  among  the  incurables.  His  ingenuity  afforded 
him  various  means  of  employing  his  time  plea- 
santly :  working  as  his  inclination  dictated,  with  his 
knife,  brush  or  needle.  In  this  way  he  passed 
nearly  two  years  and  a  half.  At  this  time  he  was 
recommended  for  pardon,  and  in  a  few  days,  obtain- 
ed his  liberty.  He  had  been  discharged  from  the 
prison  but  four  days  before  he  was  completely  re- 
stored. 

The  case  of  William  M'Donald,  now  dead,  is  a 
case  of  very  uncommon  occurrence.  He  lay  for 
more  than  two  years  pretending  palsy,  and  sub- 
mitted with  readiness  and  often  with  eagerness,  to 
many  painful  remedies.    His  "  incurable  disease" 


§3 

was  influential  in  procuring  him  a  pardon  ;  and  no 
30oner  had  he  passed  the  "  stepping  stone"  of  the 
gate,  after  he  had  obtained  his  liberty,  than  he 
threw  his  crutches  over  the  fence,  and  after  giving 
two  or  three  cheers  he  ran  away,  in  as  good  health 
as  any  one  of  the  spectators. 

PREGNANCY. 

The  next  subject  which  claims  our  attention,  is 
that  of  Pregnancy,  which,  although  not  strict- 
ly speaking,  a  disease,  still  it  is  a  condition  of  the 
female  system,  which  is  sometimes  pretended,  some- 
times concealed,  and  always  intimately  connected 
with  the  character  of  the  individual :  and  it  has 
long  been  considered  a  province  of  the  physician,, 
to  determine  the  question,  whether  pregnancy 
exists  or  not.  To  give  that  attention  to  the  subject 
which  its  importance  demands,  requires  of  us  to 
note,  and  carefully  examine  every  minute  symptom, 
in  order  to  ascertain  how  far  they  are  to  be  admits 
ted  as  evidences  of  this  state. 

Pregnancy  is  sometimes  pretended  by  the  indo- 
lent among  the  lower  orders  of  society,  either  for 
the  purpose  of  exciting  commiseration,  or  for  ob- 
taining an  asylum  in  public  charities.  It  is  some- 
times feigned  by  women  after  the  death  of  their 
husbands,  with  the  view  of  retaining  property,  and 
withholding  from  the  legal  heirs  their  rights  ;  and 
sometimes  in  order  to  extort  money  from  a  parti- 
cular individual,  or  to  destroy  his  reputation  by 
declaring  him  the  father  of  the  offspring.    Preg- 


u 

nancy  is  often  pretended  by  convicts,  for  the  pur- 
pose  of  deferring  the  execution  of  the  law,  or  to 
mitigate  punishment  already  in  execution. 

In*  the  history  of  pretended  pregnancy,  we  can* 
not  but  notice  the  case  of  Bianca  Cappello,  who  had 
very  nearly  placed  the  offspring  of  another  on 
the  throne  of  Tuscany  as  the  son  of  her  prince.* 

Male,  in  his  Forensic  Medicine,  relates  the  fol- 
lowing instance.  "  A  surgeon,  in  Birmingham;, 
(England)  being  called  to  a  pretended  labour,  a 

*  Bianca,  at  the  age  of  29,  left  her  father's  palace  at  Venice,  and  accompanied 
Petro  Bonaventuri  to  Florence,  and  during  their  journey  they  were  married  at  Bo- 
logna. While  residing  at  Florence,  in  the  greatest  •bscurity,  Francisco,  then  duke, 
but  afterwards  prince  of  Tuscany,  fell  in  love  with  her.  She  left  her  husband,  and  lived 
as  the  mistress  of  the  prince,  in  the  palace  which  he  prepared  for  her.  After  she  bad 
resided  at  Florence  abeut  nine  years,  Francisco  became  governor  of  Tuscany  by  the 
death  of  his  father.  Although  he  had  been  a  long  time  married,  and  his  wife  Donna 
Joanna,  had  borne  him  many  children,  still  he  had  no  son  to  succeed  to  his  throne, 
lie  expressed  to  his  mistress,  his  desire  of  having  an  heir,  and  she  signified  her  wish 
of  becoming  a  mother.  "But  a  long  and  uninterrupted  course  of  dissipation,  had 
so  impaired  her  constitution,  as  to  render  pregnancy  but  little  probable.  The  efficacy 
of  medicine,  of  every  nostrum,  and  superstition,  which  the  knowledge  of  the  temper 
of  the  times  afforded,  had  long  been  resorted  to.  by  Bianca,  but  in  vain  ;  when,  des- 
pairing of  success,  she  resolved  to  have  recourse  to  subtlety  and  fraud."  A  long 
premeditated  project  began  to  ripen ;  she  chose  her  confidants,  and  each  received 
•their  orders,  committing  the  whole  affair  to  the  management  of  Joanna  Sancfi. 
Several  pregnant  women  in  Florence  were  pitched  upon  for  furnishing  the  means  of 
accomplishing  her  designs.  In  the  mean  time,  the  report  of  the  pregnancy  of  the  mis- 
tress  of  the  prince  was  industriously  circulated.  "At  length  one  of  the  women  marked 
by  Saneti,  was  delivered  of  a  son,  and  the  mother  and  the  son  conveyed  to  a  house 
belonging  to  Bianca.  Saneti  making  the  woman  a  visit,  tosk  the  infant  from  its 
mother,  and  under  pretence  of  showing  it  to  some  person 'in  the  adjoining  room,  and 
under  cover  of  night,  had  it  carried  to  the  palace  of  Bianca,  to  be  produced 
as  occasion  might  serve.  Bianca  during  the  day  had  acted  the  part  of  a  woman  in 
labour.  The  duke  full  of  anxiety,  and  impatiently  expecting  her  delivery,  quitted 
not  her  room  for  a  moment;  till  at  length  exhausted  by  fatigue  and  watching,  the 
night  being  far  advanced,  he  was  prevailed  upon  to  retire,  and  to  leave  bis  beloved 
mistress  with  her  nurse  and  attendants  Bianca  contrived,  by  some  pretence,  to  rid 
herself  of  her  physicians,  who  waited  in  her  chamber,  and  who  seems  not  to  have 
been  concerned  in  the  plot ;  and  in  the  interval,  surrounded  only  by  her  confidential 
friends,  pretended  to  have  brought  forth  a  son  "  For  a  more  particular  account  4S, 
this  woman,  and  the  consequences  of  this  deception,  see  "  Female  Biography?'' 


65 

dead  child  was  presented  hira,  but  there  was  no 
placenta.  He  proceeded  to  examine  the  woman, 
and  found  the  os  tincse  in  its  natural  state  nearly 
closed,  and  the  vagina  so  much  contracted  as  not 
to  admit  the  hand.  Astonished  at  this  appearance, 
he  went  to  consult  a  medical  friend  on  the  subject; 
but  before  any  further  steps  were  taken,  the  de- 
ception was  detected.  The  woman,  in  fact,  had  ne- 
ver been  pregnant,  and  the  dead  child  was  the  bor- 
rowed offspring  of  another :  she  was  induced  to 
practice  this  artifice,  to  appease  the  wrath  of  her 
husband,  who  often  reproached  her  for  her  ste- 
rility.*" 

An  eminent  physician  of  this  city,  in  his  lectures 
on  obstetrics,  relates  the  following  case  of  pre- 
tended labour.     Being  requested  by  some  chari- 
table ladies  to  visit  a  poor  woman,  who,  as  he  was 
informed,  had  been  in  labour  three  days  ;  he  im- 
mediately complied  with  the  request,  and  found 
her  apparently,  in  a  very  distressed  situation — 
cloths  stained  with  blood  were  exhibited  as  an  evi- 
dence  that  haemorrhage  had   taken  place.     Oa 
examination,  however,  he  was  astonished  to  find, 
that   so   far   from  her  being  in  labour,  she  was 
not  even  pregnant*     He  retired  without  making 
known  his  discovery,  and  the  farce  was  kept  up  un- 
til the  charity  of  her  neighbours  had  so  abundantly 
supplied  her  with  gifts,  that  she  was  enabled  a  short 
time  afterwards,  to  furnish  a  little  shop  in  the  upper 
part  of  the  city  with  the  proceeds  of  her  artifice. 

*  Male's  Judiciarv  or  Forensic  Medicine,  p.  123 

9 


66 

The  history  of  Joanna  Southcot  must  be  fresh 
in  the  memory  of  almost  every  person.  After 
practising  a  long  imposition,  she  pretended  herself" 
pregnant  by  the  Holy  Ghost.  Dr.  Reece  of  Lon- 
don examined  her  two  separate  times,  and  as  often 
published  his  opinion,  which  was,  that  she  was 
pregnant,  although  she  was  nearly  sixty  years  of 
age.  Almost  a  week  after  her  death,  which  hap- 
pened about  the  fourteenth  month  of  pregnancy  as 
she  pretended,  she  was  opened  and  no  appearance 
of  conception  was  discoverable..* 

In  order  to  decide  that  pregnancy  does  not  exist, 
it  is  necessary  to  know  the  changes  commonly  in- 
duced in  those,  who  are  really  pregnant.  The 
following  signs  are  enumerated  by  Manningham, 
in  his  Artis  Obstetricarm  Compendium.  Signa  ex 
— Venerei  Appetitus  iEstu.  Languoris  tempore, 
Uteri  sicciiafeet  quadam  sudione  a  Coitu.  Galore 
et  Motu  in  Pelvl ;  qui  Extasis  secundaria.  Ap- 
petitu  asolitis  ad  insolita  translato.  Nausea.  Vo- 
mitu.  Virium  prostratione  per  .  duos  Menses, 
Menstruis  suppressis  cum  Euphoria.  Abdomi- 
nis complanatione.  Ore  Tincee — clauso — aucto— - 
molli.  Abdomine  antrorsum  et  deorsum.  sine  Mo* 
Testis  tumi'do.  Umbilico  elevato.  Motu  Foetus 
quarto  Mense.  Ore  Tineas  attenuato  sexto  Mense. 
Mammis  et  Papillis — duris — tumidis---eievatis, 
Areolis  Mammarum,  papulosis.  His  q.uandoque 
accedii — EiHorescentia  in  cute — Somnolentia."! 


*  Critical  Review  for  August,  181  j— Espriella's  Letters,  vol.  3,  p.23G. 


67 

These  symptoms,  however,  we  shall  find,  taken 
separately,  are  entitled  to  very  little  dependance  : 
1  shall  only  notice  the  most  prominent  of  them. 

Suppression  of  the  Menses  is  an  evidence  upon 
which  much  reliance  is  placed,  and  from  which 
women  generally  date  their  conception.  This, 
however,  without  other  signs,  is  a  very  equivo- 
cal one,  for  it  takes  place  independent  of  preg- 
nancy,* and  it  is  not  an  uncommon  occurrence  for 
the  catemeniatoflowfor  two  or  three  monthsafter 
conception.  I  am  well  acquainted  with  a  lady  of 
strict  veracity,  in  this  city,  who  has  been  the 
mother  of  six  children,  and  she  assures  me,  that 
from  the  age  of  puberty,  until  she  had  passed  her 
forty-fifth  year,  her-menstrual  discharge  was  never 
wanting  at  its  regular  periods;  that  sometimes,  du- 
ring pregnancy  and  lactation  it  was  a  little  dimin- 
ished in  quantity,  but  when  pregnant,  she  was  gen- 
erally unconscious  of  her  condition  until  the  peri- 
od of  quickening.  But  should  a  woman  wish  to 
pretend  a  suppression  of  the  menses,  it  is  an 
easy  matter  for  her  to  remove  any  appearance  of 
blood. 

A  Smelling  of  the  Abdomen  may  arise  from 
dropsy,  tympanites,  or  other  diseases,  or  there 
may  be  a  natural  anterior  obliquity  of  the  womb, 
and  an  enlarged  belly  from  obesity  alone.  In 
dropsy  there  is  generally  an  evident  fluctuation. 
In  pregnancy  there  is  none,  unless  connected  with 

*  Sola  Mensium,  Suppressio  VirginibuSj  Inappetentiam  Nauseam  et  Vomitus, 
jQstar  Utero  gestantium  ssepe  adfert :  Fluor  etram  aerosus  e  Marami*  proauit,  venue 
iac  nunquam  nisi  Gravidis.    Art  Obstet.  Compd.  p.  49. 


dropsy.  The  borborigma,  and  peculiar  sound  ex- 
cited by  gently  tapping  the  abdomen  with  the  hand, 
will  generally  distinguish  tympanites  from  preg- 
nancy. In  obesity,  as  well  as  in  dropsy  and  tym- 
panites, the  swelling  of  the  abdomen  is  generally 
uniform.  In  pregnancy,  the  tumor  usually  in- 
clines to  one  side. 

The  swelling  of  the  breasts,  their  containing  milk,* 
and  the  discolouration  of  the  areola*  are  placed  by 
Farr  among  the  certain  signs  of  pregnancy.f  But 
we  now  know  that  these  circumstances  take  place 
in  many  diseases  of  the  uterus,  and  even  some- 
times in  girls  before  the  appearance  of  the  menses. 
Thus  we  see  that  the  signs  of  pregnancy  in  the 
early  months,  may  be  easily  pretended.  Buts 
fortunately  for  the  physician,  as  the  time  progres- 
ses, his  opinion  may  be  formed  with  more  cer* 
tainty. 

The  motion  of  the  F&lus  which  happens  about  the 
fourth  month  of  gestation,  if  discoverable,  will  ge- 
nerally enable  us  to  decide  with  correctness,  and 
as  this  is  of  much  importance,  the  examination  can- 
not be  conducted  with  too  much  circumspection. 

"  To  excite  and  distinguish  this  motion,"  says 
Baudelocque,  "advance  the  finger,  introduced  into 
the  Vagina  to  the  body  of  the    Uterus3  near  the 


*  Instances  are  related,  in  which  the  breasts  of  men  have  contained  milk.  Ray, 
in  his  work  on  the  Wisdom  of  God  in  Creation,  relates  the  case  of  a  man  who,  after 
the  death  of  his  wife,  applied  a  young  infant  which  she  had  left,  to  his  breast  to  pa- 
cify it,  because  there  was  no  wet  nurse  in  the  village,  and  he  was  surprised  to  find 
that  it  drew  milk,  "  upon  which  it  subsisted,"  says  Ray?  •*  Btltil  it  was  old  enough 
to  be  weaned.     See  Ray  on  Creation,  p.  2?7. 

t  Fan's  Forensic  Mediciae3  p.  3§. 


base  of  its  neck,  or  as  high  as  possible,  either  be- 
fore or  behind  :  and  we  apply  the  other  hand*  over 
the  pelvis,  in  order  to  fix  the  fundus:  we  then  agi- 
tate it  upward  and  downward,  with  the  finger  and 
the  hand,  till  we  distinguish  the  movement  in 
question  :  observing,  however,  not  to  mistake  the 
motion  of  the  uterus  for  that  of  the  child."f 

In  addition  to  the  signs  which  have  been  noticed 
as  characterising  the  state  of  pregnancy,  it  is  of 
consequence  to  determine  whether  the  female  does 
not  labour  under  an  actual  incapacity  to  conceive. 
The  causes  which  may  produce  such  a  condition, 
are  mal-conformation  of  the  genital  organs— adhe- 
sions of  the  sides  of  the  vagina — a  schirrhus  of  the 
uterus— a  long  continued  or  profuse  fluor  albus — 
scantiness  of  the  menses,  or  an  excessive  discharge 
of  them.  In  detecting  feigned  pregnancy,  the  age.i: 
is  likewise  a  material  consideration,  conception 
being  confined  in  this  climate,  with  very  few  ex- 
ceptions, to  the  period  of  life  between  the  fifteenth 
and  forty-sixth  year. 

"  If  the  mouth  of  the  uterus  is  firm,"  says  Dr. 
Stringham,  "and  we  can  discover  the  transverse 
ridge,  and  the  usual  signs  of  pregnancy  are  want- 
ing, we  may  venture  an  opinion  that  conception 
has  not  taken  place."|| 


*  Previously  dipped  in  cold  water.    Slringhani's  Lectures,  M.  S. 

f  Baudelocque,  Midwifery,  p.  146. 

+  Fceminae  juniores  raro,  ante  concipiunt,  quam  menstrua  iis  contigerint. 

Art.  Obsiet.  Compend.  p.  49. 
'j  Manuscript  Lectures,  1816. 


DELIVERY. 

We  have  seen  that  delivery  is  sometimes  preten- 
ded •  and  here  it  must  be  remembered,  that  every 
moment  lost  in  ascertaining  the  truth,  increases 
the  difficulty  of  detection.  All  writers  on  Fo- 
rensic Medicine  agree,  that  the  examination  of  the 
woman,  should  take  place  within  at  least  Jive  days 
after  delivery,  in  order  to  arrive  at  any  degree  of 
certainty,, 

.  The  changes  produced  by  delivery,  and  which 
we  may  expect  to  find  upon  examination,  are,  a 
swelling  and  redness  of  the  external  organs  of  ge- 
neration, and  an  enlarged  capacity  of  the  vagina, 
both  arising  from  the  passage  of  the  child  ;  the 
mouth  of  the  uterus  a  little  open  and  soft ;  the  ab- 
dominal muscles  flaccid  and  wrinkled;  the  ap- 
pearance of  the  linea  albucentia,  or  small  white 
lines  upon  the  abdomen,  which  frequently  remain 
for  a  long  time,  and  do  not  therefore  indicate  re- 
cent parturition.  Other  evidences  of  delivery 
having  taken  place,  within  a  short  time,  are,  a  dis- 
tended state  of  the  mammse ;  their  containing 
milk ;  the  erection  of  the  nipple ;  the  darkened 
colour  of  the  areola;  the  presence  of  the  lochia, 
which  within  six  or  eight  days  is  very  material  to 
the  formation  of  a  correct  opinion.  The  Lochia 
can  readily  be  distinguished  from  the  menstrual 
discharge,  by  its  peculiar  smell ;  its  colour  at 
first  is  that  of  pure  blood,  and  it  gradually  be- 
comes paler  until  it  ceases  to  flow  altogether.  If 
these  symptoms  are  wanting,  we  may  conclude 


71 

with  much  certainty  that  delivery  has  not  takes 
place  within  the  time  specified, 


There  are  some  other  complaints,  the  assump- 
tion of  which  the  physician  is  sometimes  called  to 
witness,  but  which  are  of  too  rare  occurrence  t© 
require  a  very  particular  investigation  in  this  dis- 
sertation :  I  shall  therefore  conclude  what  I  have 
to  offer  upon  the  subject  of  Feigned  Diseases  by 
relating  some  of  those  cases  which  have  come  un- 
der my  observation. 

During  the  first  few  weeks  of  my  attendance  at 
the  Prison,  I  had  frequent  opportunities  of  witnes- 
sing a  pretended  suppression  of  urine  among  the  fe- 
male prisoners,  particularly  the  blacks.  Indeed, 
at  one  time,  it  was  almost  epidemic.  Ey  reference 
to  old  registers,  I  found  this  was  a  common  com- 
plaint immediately  after  the  initiation  of  almost 
every  "  Resident  Physician."  The  details  of  two 
cases,  of  which  I  took  particular  notice*  will  be 
sufficient  for  our  present  purpose. 

A  black  girl,  who,  as  I  afterwards  learned,  very 
ghortly  after  her  commitment,  resolved  that  shs 
would  not  do  a  day's  work  during  her  confinement; 
made  various  complaints,  for  some  of  which  effec- 
tual remedies  were  found,  particularly  that  of  pain, 
for  she  having  discovered  that  I  generally  employ- 
ed blisters  for  local  inflammation,  had  recourse  to 
complaints  which  required  in  her  opinion  less 
painful  remedies.  One  occurrence  with  this  pa- 
tient I  must  be  permitted  to  mention,  as  it  shaws 


(he  great  necessity  of  attending  not  merely  to  pre- 
scription, but  to  the  execution  of  our  directions* 
She  complained  of  pain  in  the  bowels,  which,  to 
all  appearance  was  severe^  Having  employed 
large  quantities  of  cathartic  medicine  without 
benefit,  I  prescribed  a  large  blister  for  the  abdo- 
men i  fearing  she  might  object  to  its  application, 
I  gave  the  nurse  a  strict  charge  to  apply  it  herself. 
The  next  morning  I  was  surprised  to  learn  that 
the  blister  had  not  been  dressed ;  she  said  it  had 
not  yet  drawn;  that  she  "guessed  the  salve  was 
not  good.'*  But  as  fifteen  hours  had  elapsed,  I 
concluded  it  was  full  time  for  it  to  produce  its 
effects,  and  therefore  requested  an  inspection;  but 
to  this  she  objected,  pleading  her  modesty  as  an 
excuse ;  but  with  her,  I  knew  all  modesty  to  be 
affected,  and  as  her  symptoms  did  not  appear  at 
all  improved,  I  did  not  long  parley  with  her; 
and,  Upon  examination,  I  found  the  plastered  sur- 
face of  the  leather  uppermost.  She,  of  course, 
knew  nothing  of  the  circumstance,  but  the  evidence 
that  the  nurse  had  made  no  mistake  in  applying  it* 
was  too  strong  for  her  to  substantiate  her  igno- 
rance ;  and,  to  prevent  punishment,  she  acknowT- 
ledged  that  she  had  taken  it  off  because  she  was 
afraid  it  was  too  large.  At  length  she  concluded 
that  she  would  try  what  a  pretended  suppression  of 
urine  would  do  for  her;  and  certainly  her  ingenu- 
ity deserves  credit  for  the  manner  in  which  she 
introduced  her  new  complaint.  She  first  com- 
plained of  pain  in  the  hypogastric  region,  and  of  a 
burning  sensation  accompanying  the  evacuation  of 


73 

the  bladder.     These  symptoms  according  to  her 
account,  did  not  yield  to  any  remedies,  but  were 
much  aggravated  the  next  day,  and  the  urine  was 
discharged  in  small  quantities  and  with  great  diffi- 
culty.    The  following  morning,  with  a  great  deal 
of  apparent  modesty  and  delicacy,  she  informed 
me  that  she  could  not  pass  one  drop  of  water,  and 
was  in  great  pain.     Upon  examination,  I  found  the 
bladder  very  much  distended,  and  by  means  of  the 
catheter,  drew  off  a  large  quantity  of  high  colour- 
ed urine.     From  the  first,  as  might  be  expected, 
her  appetite  appeared  bad,  and  now  she  eat  no- 
thing ;  and  her  pulse  and  tongue  exhibited  signs 
of  general  irritation.    The  introduction  of  the  ca- 
theter twice  a-day,  together  with  other  remedies, 
was  continued  for  three  weeks,  at  which  time  acci- 
dent led  to  the  detection  of  the  imposition.    Busi- 
ness called  me  from  the  prison  for  one  day,  during 
which  time,  I  engaged  a  friend  to  attend  to  my 
duties,  but  this  patient  by  some  accident  was  neg- 
lected.    The  next  morning,  before  breakfast,  I 
was  called  to  her  :  her  situation  at  first  appeared 
distressing  and  urgent.     I  found  her  groaning  and 
restless  with  pain  ;  four  or  five  persons  attending 
her  and  blaming  me  for  my  delay.     Upon  exami- 
nation, however,  I  found  the  hypogastric  region 
very  soft,  and  not  the  least  appearance  of  a  tumour 
discoverable.    I  immediately  suspected  deception, 
and   introduced   the  catheter,   but  could  obtain 
scarcely  four  ounces  of  urine.     I  accused  her  of 
imposition ;  she  denied  it  in  peremptory  terms, 
and  wondered  that  I  could  think  she  would  be 
guilty  of  such  an  offence.     Upon  inquiry,  how- 

10 


'  74. 

ever,  I  discovered  that  during  the  night,  she  got 
out  of  bed  and  discharged  her  urine  in  the  tub. 
Notwithstanding  this  evidence,  which  was  attested 
by  two  persons,  she  still  persisted  in  the  denial, 
and  cried  a  great  deal ;  said  the  prisoners  were  all 
against  her ;  that  she  had  not  a  friend  in  the  place ; 
but  during  this  discussion  she  forgot  her  agonies, 
which  seemed  very  much  to  confuse  her.  At  length 
she  lay  down  and  covered  her  head  with  the  blan- 
kets. She  was  now  ordered  to  be  confined  in  a 
room  alone,  where  it  was  impossible  for  her  to 
conceal  her  urine.  The  next  day  she  confessed  her 
imposition  and  begged  my  forgiveness. 

The  detection  of  this  case  led  me  to  examine 
more  particularly  into  other  cases  of  a  similar 
kind.  I  shall  mention  the  following  instance,  be- 
cause there  was  something  attending  it,  worthy  of 
observation. 

A  mulatto  girl,  who  was  confined  in  the  prison 
for  a  second  offence,  had  been  on  the  hospital  lists 
for  the  greater  part  of  the  two  last  years.  At  length 
she  could  not  pass  her  urine.  The  catheter,  to- 
gether with  the  use  of  diuretic  remedies  of  various 
kinds  was  employed  ;  but  the  relief  she  obtained, 
appeared  to  be  only  temporary.  The  catheter  was 
introduced,  at  least  as  often  as  twice  a  day  for  near- 
ly four  weeks.  There  was  great  difficulty  attend- 
ing the  first  introduction  of  the  instrument,  which 
arose  from  a  singular  formation  of  parts.  The 
termination  of  the  urethra  was  at  least  an  inch  and 
a  half  from  the  entrance  of  the  vagina.  This  pa^ 
tient,  however,  like  two  others  with  the  same  com- 
plaint, began  to  recover  very  fast.     The  day  that 


75 

the  first  case  was  delected,  sbe  passed  a  little  water, 
and  the  next  day,  the  necessity  of  introducing  the 
catheter  was  obviated  by  a  very  happy  and  com- 
fortable removal  of  all  unpleasant  symptoms. 

I  will  just  remark  that  the  white  tongue,  which 
these  pretenders  generally  have,  and  which  was  no- 
ticed in  the  case  first  related,  may  be  easily  account- 
ed for.  A  considerable  coat  upon  the  tongue  may 
readily  be  produced  by  any  person  that  will  take 
the  trouble  to  abstain  from  food  and  drink  for 
tweniv  four  hours:  hence,  we  see  that  most  per- 
sons, although  they  enjoy  an  uninterrupted  state  of 
health,  hive  their  tongues  more  or  less  furred  in  the 
morning.  Most  pretenders  understand  this  very 
well  ;  hence,  a  bad  appetite  is  almost  an  universal 
symptom  with  them,  and  for  the  same  reason  they 
seldom  eat  any  thing  until  after  they  have  been 
visited  by  the  physician. 

A  foul  tongue,  by  most  people,  is  considered  as 
a  sure  sign  of  fever;  but  nothing  can  be  more  er- 
roneous. It  may,  with  more  propriety,  be  consider- 
ed as  the  consequence  merely  of  a  derangement  of 
the  stomach  ;  and  as  an  affection  of  this  organ  is 
more  or  less  an  attendant  upon  general  irritation, 
so  the  tongue  generally,  though  not  always,  be- 
comes coated  in  fevers  :  and  upon  this  principle  we 
think,  may  be  explained  the  other  symptoms  of 
irritation  which  we  mentioned  in  the  first  case  of 
pretended  strangury. 

There  was  a  beggar  in  a  village  in  this  state,  who 
for  some  time  subsisted  upon  the  charity  of  the  in- 
habitants, by  frequently  exhibiting  to  them  the 
appearance  of  a  very  extensive   and  foul  ulcer 


76 

upon  his  leg,  which,  as  he  pretended,  disabled  him 
from  labour.  He  was  observed  one  morning  very 
busily  engaged  under  a  shed,  by  some  boys,  who 
watched  him  in  his  operations,  and  discovered  that 
he  was  gluing  to  his  leg  a  thin  piece  of  beef,  which, 
when  he  had  finished,  they  went  up  to  observe,  and 
found  not  his  old,  but  an  excellent  new  ulcer.  It 
is  almost  needless  to  observe,  that  when  this  cir- 
cumstance was  made  public,  he  used  his  legs  for 
quite  another  purpose. 

Perhaps  at  some  future  period  I  may  offer  some- 
thing more  upon  the  subject  which  has  now  been 
but  slightly  considered.  The  numerous  instances 
of  imposition  which  have  been  detected,  and  the 
many  more  which  it  is  to  be  feared  elude  the  ob- 
servation of  the  physician,  bespeak  its  importance. 
The  task  of  thus  exposing  the  depravity  of  human 
nature,  is  by  no  means  as  pleasant  as  it  is  necessary, 
and  we  think  enough  has  been  said,  to  show,  that 
from  the  highest  circles  of  affluence,  to  the  lowest 
grade  of  poverty  ;  from  the  decrepitude  of  age,  to 
the  helplessnses  of  infancy,  are  to  be  found  those 
who  feign  diseases. 


ERRATA. 

Page  9,  line  9,  for  witnessed  instances  of  the,  read  witnessed  the 

31  9,  for  Zacheus  read  Zacchias 

32  3,  from  the  bottom,  for  Billingham  read  Bellingham. 
36    Note     for  Critinge  read  Cretinage.  i 

40  for  d1  avor  cru  au  pouvoir,  magique,  etpartageJ  Us  read  d'avoir 

Til  au  pouvoir  magique,  et  partage  les. 
Page  62  line  ID  forJBeUodona  read  Belladonna. 

55    Note    for  Lewis  Culkn  read  Lewis's  Cullen. 


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